When Time Is Critical, Is Informed Consent Less So? A Discussion of Patient Autonomy in Emergency Neurosurgery.

Abstract

Neurosurgical interventions frequently take place in an emergency setting. In this setting, patients often have impaired consciousness and are unable to directly express their values and wishes regarding their treatment. The limited time available for clinical decision making holds great ethical implications as the informed consent procedure may become compromised. The ethical situation may be further challenged by different views between the patient, relatives and the neurosurgeon; the presence of advance directives; innovative procedures; or if the procedure is part of a research project. In this moral opinion piece, we discuss the implications of time constraints and a lack of patient capacity for autonomous decision making in emergency neurosurgical situations. We also discuss potential solutions to these challenges that might help to improve ethical patient management in emergency settings.