Primo non nocere or maximum survival in grade 2 gliomas? A medical ethical question

Abstract

In important life-changing decisions there is no "one size fits all". We find that it is ethically acceptable to offer more extensive surgery than is possible within the concept of maximal safe surgery as a treatment option, when balancing the principles of beneficence, non-maleficience, autonomy and justice supports the decision. At the same time it must be remembered that even when the patients have made a well-informed decision, some will regret it. In that situation it will be our job as healthcare professionals to support them and help carry some of this burden.

EANO guidelines on the diagnosis and treatment of diffuse gliomas of adulthood

“…Neurological deficits that occur because of surgery can sometimes be predicted preoperatively. In exceptional situations, anticipated minor deficits (such as quadrantanopia) might be deemed acceptable but only after a thorough process of shared decision-making 42 . Patients and their caregivers should also be informed that neurosurgery is always associated with some unpredictable risks.…”

Advancements in predicting outcomes in patients with glioma: a surgical perspective

“…Thus, a one-dimensional focus on eloquent brain regions associated with risk of physical functional impairment may not always be in the patients' interest. Shared decision-making, making patients' part of the difficult treatment decisions may be feasible in some patients, especially if considering planned deficits [86][87][88]. Predicting impact and course of such deficits and the consequences for quality of life is still very difficult.…”

The ethics of “primo non nocere”, professional responsibility and shared decision making in high-stakes neurosurgery

“…Having been alerted to a debate on high-stakes neurosurgery policy ensuing in Acta Neurochirurgica because of an article by Brennum and colleagues [1], I have been kindly invited to submit a comment from the point of view of a medical ethics researcher. I will describe some underlying constituents of the apparent disagreement between Brennum's team and of Duffau, who criticised their original suggestion in an editorial [2], taking into acount a recent response by Brennum's team [3].…”