Ethics consultations in stroke and neurological disease: a 7-year retrospective review.

BACKGROUND AND
PURPOSE: To describe the reasons for and methods of resolution of ethics consultations conducted in neurological and neurointensive care units affiliated with a single health care facility.
METHODS: We performed a retrospective review of all ethics consultations contained in the Cleveland Clinic Ethics Database from 1998 to 2004 involving patients from neurosurgical and neurological units. Forty-nine eligible consultations were identified and all patients had primary neurological or neurosurgical diagnoses. Primary outcome measures were reasons for ethics consultations and the methods for resolution.
RESULTS: The most common diagnoses of patients who received an ethics consultation were stroke (total 26; ischemic stroke 12, intracerebral hemorrhage 10; subarachnoid hemorrhage 4) and brain tumor (7). The most frequent reasons for consultations were withdrawal of life support/futility (15), conflict (8), and capacity evaluations (7). The main reasons for consults were not statistically different in stroke versus non-stroke patients. However, a subgroup analysis of withdrawal of ventilatory support/futility reasons found significant differences between the groups (P = 0.0003, Fisher's exact), particularly in the frequency of issues related to death by neurological criteria (DNC) and requests for aggressive medical care despite poor prognoses. In 53% of consultations, the consultant organized and led meetings with family members, half of which were attended by the primary attending staff.
CONCLUSION: Although there may be a role for ethics consultations in neurological practice, future studies are needed to better clarify how to optimize their use.