Ethical Considerations in Neuroprognostication Following Acute Brain Injury

Author:

Lissak India A.1,Edlow Brian L.12,Rosenthal Eric1,Young Michael J.1

Affiliation:

1. Department of Neurology, Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts

2. Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts

Abstract

AbstractNeuroprognostication following acute brain injury (ABI) is a complex process that involves integrating vast amounts of information to predict a patient's likely trajectory of neurologic recovery. In this setting, critically evaluating salient ethical questions is imperative, and the implications often inform high-stakes conversations about the continuation, limitation, or withdrawal of life-sustaining therapy. While neuroprognostication is central to these clinical “life-or-death” decisions, the ethical underpinnings of neuroprognostication itself have been underexplored for patients with ABI. In this article, we discuss the ethical challenges of individualized neuroprognostication including parsing and communicating its inherent uncertainty to surrogate decision-makers. We also explore the population-based ethical considerations that arise in the context of heterogenous prognostication practices. Finally, we examine the emergence of artificial intelligence-aided neuroprognostication, proposing an ethical framework relevant to both modern and longstanding prognostic tools.

Funder

NIH BRAIN Initiative

NIH Director's Office

Tiny Blue Dot Foundation, and American Academy of Neurology

Publisher

Georg Thieme Verlag KG

Subject

Neurology (clinical),Neurology

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