Citation

Lazaridis C. Neurocrit. Care 2019; 30(1): 33-41.

Affiliation

The University of Chicago Medicine, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA. lazaridis@uchicago.edu.

Copyright

(Copyright © 2019, Holtzbrinck Springer Nature Publishing Group)

DOI

10.1007/s12028-018-0595-8

PMID

30143963

Abstract

BACKGROUND: Withdrawal of life-sustaining treatment (WOLST) is the leading proximate cause of death in patients with perceived devastating brain injury (PDBI). There are reasons to believe that a potentially significant proportion of WOLST decisions, in this setting, are premature and guided by a number of assumptions that falsely confer a sense of certainty.

METHOD: This manuscript proposes that these assumptions face serious challenges, and that we should replace unwarranted certainty with an appreciation for the great degree of multi-dimensional uncertainty involved. The article proceeds by offering a taxonomy of uncertainty in PDBI and explores the key role that uncertainty as a cognitive state, may play into how WOLST decisions are reached.

CONCLUSION: In order to properly share decision-making with families and surrogates of patients with PDBI, we will have to acknowledge, understand, and be able to communicate the great degree of uncertainty involved.

Language: en

Keywords

Brain injury; Chronic conditions and rehabilitation; Decision-making; Disability; End-of-life issues