Patients with critical neurologic illness typically have impaired capacity to make their own medical decisions. In these cases, neurologists need to make medical decisions based on advance directives (such as a living will) or the decisions of a surrogate. A hypothetical case of a 60-year-old man with an intracerebral hemorrhage is used to highlight some of the difficulties that can occur when attempting to apply general statements made in a living will to a specific medical treatment decision. The ethical and legal issues surrounding surrogate decision making as they apply to acute critical neurologic disease are discussed, along with suggestions for how to resolve potential disagreements.
Address correspondence to Dr Darin Zahuranec, University of Michigan, Cardiovascular Center, Room 3392, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, firstname.lastname@example.org.
Relationship Disclosure: Dr Adelman receives research support from the Agency for Healthcare Research and Quality for his participation in the Solutions for Vertigo Presentations in the Emergency Department (SOLVE) trial; Medtronic, Inc., for serving as investigator on a trial evaluating a transcatheter aortic valve replacement system; and the NIH for participation in the Platelet-Oriented Inhibition in New TIA and Minor Ischemic Stroke (POINT) trial. Dr Zahuranec receives research support from Medtronic, Inc., for serving as investigator on a trial evaluating a transcatheter aortic valve replacement system and from the NIH for a K23 career development award to study end-of-life decision making in patients with intracerebral hemorrhage.
Unlabeled Use of Products/Investigational Use Disclosure: Drs Adelman and Zahuranec report no disclosure.