"Do Everything" versus realistic surgical interventions: navigating the road to shared decision-making in trauma...

Area of Science:

• Medical Ethics
• Surgical Decision-Making
• Palliative Care

Background:

• Acute care surgeons often face family requests to

Purpose of the Study:

• To explore ethical challenges in critical care decision-making when patient recovery is unlikely.
• To provide a framework for surgeons managing family expectations and providing medically appropriate care.
• To address the moral tension between preserving life and avoiding harm.

Main Methods:

• Review of the utility and limitations of risk calculators and prognostic tools in trauma care.
• Examination of the best case/worst case communication model for discussing prognosis.
• Discussion of counseling strategies for families with unrealistic recovery expectations.

Main Results:

• Prognostic tools can aid decision-making but have limitations.
• Structured communication models like best case/worst case improve family understanding.
• Effective counseling is crucial when patient outcomes are poor.

Conclusions:

• A framework integrating prognostic tools, structured communication, and family counseling supports compassionate and ethically sound critical care decisions.
• This approach helps reconcile the desire to heal with the obligation to avoid harm and respect patient values.
• Navigating "do everything" requests requires balancing aggressive treatment with realistic expectations and patient-centered care.