Citation

Graham M. Bioethics 2020; ePub(ePub): ePub.

Affiliation

Uehiro Centre for Practical Ethics, Oxford University, UK and Wellcome Centre for Ethics and Humanities, Oxford University, UK.

Copyright

(Copyright © 2020, John Wiley and Sons)

DOI

10.1111/bioe.12737

PMID

32124448

Abstract

Prognosis after severe brain injury is highly uncertain, and decisions to withhold or withdraw life-sustaining treatment are often made prematurely. These decisions are often driven by a desire to avoid a situation where the patient becomes 'trapped' in a condition they would find unacceptable. However, this means that a proportion of patients who would have gone on to make a good recovery, are allowed to die. I propose a shift in practice towards the routine provision of aggressive care, even in cases where the probability of survival and acceptable recovery is thought to be low. In conjunction with this shift, I argue in favour of a presumption towards withdrawing life-sustaining treatment, including artificial nutrition and hydration, when it becomes clear that a patient will not recover to a level that would be acceptable to them. I then respond to three potential objections to this proposal.

© 2020 The Authors. Bioethics published by John Wiley & Sons Ltd.

Language: en

Keywords

brain injury; decision-making; end-of-life treatment; neuroethics; prognostic uncertainty