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Discussing Life-sustaining Therapy With Surrogate Decision Makers

Hwang, David Y. MD

doi: 10.1212/CON.0000000000000417
Ethical and Medicolegal Issues

ABSTRACT Clinicians caring for patients with severe stroke in intensive care units often grapple with requests from surrogate decision makers for life-prolonging treatment that members of the care team may believe to be futile. An example is a surrogate decision maker’s request to place a tracheostomy and feeding tube in a patient who, in the clinical judgment of the neurocritical care team, is very unlikely to recover interactive capacity. This article presents a case, discusses definitions of medical futility, and summarizes recommended steps for mediating conflict regarding potentially inappropriate treatment.

Address correspondence to Dr David Y. Hwang, Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine, PO Box 208018, New Haven, CT 06520, david.hwang@yale.edu.

Relationship Disclosure: Dr Hwang has received personal compensation for speaking engagements for the Mayo Clinic and The Pennsylvania State University and research/grant support from the American Brain Foundation, the Apple Pickers Foundation, the Neurocritical Care Society, and the National Institute on Aging, via its Loan Repayment Program.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Hwang reports no disclosure.

© 2017 American Academy of Neurology
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