Ethics consultations in stroke and neurological disease: a 7-year retrospective review

To describe the reasons for and methods of resolution of ethics consultations conducted in neurological and neurointensive care units affiliated with a single health care facility.

We performed a retrospective review of all ethics consultations contained in the Cleveland Clinic Ethics Database from 1998 to 2004 involving patients from neurosurgical and neurological units. Forty-nine eligible consultations were identified and all patients had primary neurological or neurosurgical diagnoses. Primary outcome measures were reasons for ethics consultations and the methods for resolution.

The most common diagnoses of patients who received an ethics consultation were stroke (total 26; ischemic stroke 12, intracerebral hemorrhage 10; subarachnoid hemorrhage 4) and brain tumor (7). The most frequent reasons for consultations were withdrawal of life support/futility (15), conflict (8), and capacity evaluations (7). The main reasons for consults were not statistically different in stroke versus non-stroke patients. However, a subgroup analysis of withdrawal of ventilatory support/futility reasons found significant differences between the groups (P = 0.0003, Fisher's exact), particularly in the frequency of issues related to death by neurological criteria (DNC) and requests for aggressive medical care despite poor prognoses. In 53% of consultations, the consultant organized and led meetings with family members, half of which were attended by the primary attending staff.

Although there may be a role for ethics consultations in neurological practice, future studies are needed to better clarify how to optimize their use.