Addressing Ethical Conundrums in Neuropalliative Care

Ethical decision-making in the care of neurologic patients is difficult because patient autonomy is often threatened early by aphasia, dementia, or the sudden development of a catastrophic illness. Complex questions of surrogate decision-making are frequent, and end-of-life issues such as withdrawal of life-sustaining care and brain death are ever-present. This article frames the approach to these common scenarios by rooting them in the principles of medical ethics and offering the practical guideline of the four-topic technique to inform decision-making. In more recent developments, the determination of brain death, or death by neurologic criteria, has been reexamined through the World Brain Death project, an international panel that is deciding on the clinical criteria needed to diagnose brain death.