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Futility in Neurosurgery: A Patient-Centered Approach

Honeybul, Stephen FRCS (SN), FRACS*; Gillett, Grant R. FRACS, MPhil; Ho, Kwok FRCICM, PhD§

doi: 10.1227/NEU.0000000000000014
Special Article

The concept of futility has been a source of discussion for many years. Even though it is tempting to propose that an action or clinical intervention should be deemed futile if it does not achieve the goals of that action, further clarification is needed in terms of the nature of the likely outcomes of an intervention and the probabilities of various outcomes being achieved. The outcome, in an age of balance between autonomy and necessity, should, at a minimum, be acceptable to the person on whom the intervention is to be performed. This is especially the case when considering outcome following decompressive craniectomy for severe traumatic brain injury, in which certain outcomes are likely to be severely impaired states that the patient would consider unacceptable. In this article, we use some key ethical concepts such as substantial benefit and the risk of unbearable badness to explore the concept of futility in severe traumatic brain injury and, by linking that to recent advances in neurosurgical science, propose a pragmatic patient-centered approach to deal with the concept of futility.

ABBREVIATIONS: ICP, intracranial pressure

mRS, modified Rankin Score

*Department of Neurosurgery, Sir Charles Gairdner Hospital and Royal Perth Hospital, Perth, Western Australia, Australia;

Dunedin Hospital and Otago Bioethics Centre, University of Otago, Dunedin, New Zealand;

§Department of Intensive Care Medicine and School of Population Health, University of Western Australia, Perth, Western Australia, Australia

Correspondence: Stephen Honeybul, FRCS (SN), FRACS, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia. E-mail:

Received February 02, 2013

Accepted May 30, 2013

Copyright © by the Congress of Neurological Surgeons