Principles of Neurologic Ethics

Neuroethics refers to the branch of applied bioethics pertaining to the neurosciences and emerging technologies that impact our ability to understand or enhance a human mind. In the setting of emergency medicine, the clinician will encounter neuroethical dilemmas pertaining to the acutely brain injured or impaired; similar to other ethical decisions encountered in emergency medicine, such neuroethical dilemmas are often complicated by insufficient information regarding the patient’s wishes and preferences and a short time frame in which to obtain this information. This review examines the basis of neuroethics in emergency medicine; neuroethical inquiry; the neuroscience of ethics and intuition; issues regarding autonomy, informed consent, paternalism, and persuasion; shared decision making; situations in which decision-making capacity is in question; beneficence/nonmaleficence; incidental findings and their implications; risk predictions; and issues of justice. The figure shows the use of tissue plasminogen activator (t-PA) for cerebral ischemia within 3 hours of onset and changes in outcome due to treatment. Tables list common ethical theories, virtues/values of an acute care provider, components of informed consent discussion unique to t-PA in acute ischemic stroke, models of the physician-patient relationship, eight ways to promote effective shared decision making, components of capacity assessment, and emergency department assessment of futility. This review contains 1 figure, 9 tables, and 90 references. Keywords: Ethics, autonomy, shared decision-making, moral dilemmas, framing, decision-making capacity, beneficence and nonmaleficence