Ethical Considerations in Chronic Brain Injury

Abstract

A growing number of individuals are living with chronic traumatic brain injury. As these individuals and their families attempt to reintegrate into their communities, several ethical questions arise for clinicians and researchers. These include issues around alignment of perspectives and priorities, as well as responsibilities for ongoing treatment, education, community outreach and research. An action plan for addressing these questions is outlined.A chronic traumatic brain injury (TBI) is one that results in longstanding sequelae that may include cognitive deficits, motor impairment, mood and psychiatric symptoms, and secondary medical conditions [1,2]. These sequelae can range from mild to very severe, and can change dynamically over time. Individuals living with chronic TBI may experience challenges in all aspects of functioning, affecting both the individual and family. Discussion

Mindful Care: Nursing Strategies in Traumatic Brain Injuries: A Brief

“…A significant challenge that may arise when caring for a TBI patient includes decision making, especially when the patient is unable to provide informed consent themselves. Nurses are ethically responsible for involving surrogate decision makers in critical choices regarding treatment options and end of life decisions [6]. Furthermore, this topic can become an ethical dilemma for nursing staff when discussing end-of-life care with the surrogate decision maker if the patient cannot speak for themselves.…”

“…These ethical considerations may involve decisions regarding withdrawal of care, organ donation, or the tradition to palliative care. For instance, the study showed that one of the biggest challenges faced by clinicians working with TBI patients is deciding when it is appropriate to tell a patient and family regarding a poor prognosis [6]. Thankfully, clinicians can frame these discussions based on their perspective and offer an empathic viewpoint for families and patients.…”

Looking Ahead: Traumatic Brain Injury, Ethics, and Discharge Planning

“…The final ethical issue that I will focus on, but perhaps the most fundamental one when considering TBI discharge planning from inpatient rehabilitation, is access to services, which is a social justice and equity issue. As a society, we invest more in emergency and acute care services than the long-term care of people with TBI, when the injury is akin to chronic illness 12…”

“…As a society, we invest more in emergency and acute care services than the long-term care of people with TBI, when the injury is akin to chronic illness. 12 Meixner and O'Donoghue note that "Survivors now persist in a precarious situation where they struggle to receive needed services in a healthcare system focused on cost containment driven by medical necessity and managed care." 13(p72) These are social justice and equity issues that need serious attention and while bedside decisions about discharge from inpatient rehabilitation are being made, the larger structural and access issues are even more critical for persons who often need…”