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Convergent Expert Views on Decision-Making for Decompressive Craniectomy in Malignant MCA Syndrome

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Abstract

Background and Purpose

The decision to perform decompressive craniectomy for patients with malignant MCA syndrome can be ethically complex. We investigated factors that clinicians consider in this decision-making process.

Methods

A survey including clinical vignettes and attitudes questions surrounding the use of hemicraniectomy in malignant MCA syndrome was distributed to 203 neurosurgeons, neurologists, staff and residents, and nurses and allied health members specializing in the care of neurological patients. These were practicing health care providers situated in an urban setting in Canada where access to health care is covered by national policy and is a human right.

Results

Eighty-eight participants responded to survey. All participants unanimously supported the procedure for young and healthy patients. Advanced age, the presence of aphasia, comorbid medical conditions, and poor baseline functional status were dominant factors associated with increasing reluctance to offer surgical decompression. Patients’ previously expressed wishes were also an important consideration. Eighty-six percent of respondents agreed that withholding surgery is ethically justified if the outcome is perceived as futile.

Conclusions

Health care providers use similar factors to determine if aggressive management is justified given anticipated burden on patient quality of life and extended impact on society. This convergence can be harnessed beneficially for the transparent communication of medical options in the ethically complex setting of decompressive hemicraniectomy post-stroke.

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Acknowledgments

This study was not supported by any direct source of funding, but was enabled by resources available to Dr. Judy Illes. The authors declare no financial conflicts of interest.

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Authors and Affiliations

  1. Division of Neurosurgery, University of British Columbia, 950 West 10th Avenue, Vancouver, BC, Canada, V5Z 1M9

    Daniel Mendelsohn & Charles S. Haw

  2. National Core for Neuroethics, Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada

    Judy Illes

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  1. Daniel Mendelsohn
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Correspondence to Daniel Mendelsohn.

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Mendelsohn, D., Haw, C.S. & Illes, J. Convergent Expert Views on Decision-Making for Decompressive Craniectomy in Malignant MCA Syndrome. Neuroethics 7, 365–372 (2014). https://doi.org/10.1007/s12152-014-9206-3

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  • DOI: https://doi.org/10.1007/s12152-014-9206-3

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