Real-Life Decision Making
Neurologists deal with comatose patients who might or might not be brain
dead. Once the brain has died, the heart and lungs can be kept going with
medical equipment. But they will never function on their own and the person
will never wake up.
Sometimes neurologists have to make a decision as to whether the person
is likely to come out of a coma. When neurologists believe that there is a
chance the person will wake up, they treat the patient very aggressively.
That means they do everything possible to care for the patient and to try
to bring them out of the coma.
If they decide the patient is not likely to ever come out of the coma,
they might decide to treat less aggressively, or to withdraw treatment. This
is likely to result in the heart and lungs ceasing to function.
You are a neurologist. You have been treating a comatose patient who has
experienced a severe brain injury in a car accident.
Based on your medical experience, you believe that this person's
injuries are too severe. You believe he has no chance of ever coming out of
the coma. You must decide whether to withdraw aggressive treatment or continue
treating. Before making that decision, you are required to perform a neurological
examination.
The examination will take quite a bit of time, and you are very busy. You
have been up most of the night with a sick patient. You have many other patients
waiting to see you. You are already behind schedule today and you wonder when
you will finally get to go home and get some sleep.
You wonder if spending the time on the complete neurological examination
is really necessary. You are certain what your findings will be. But you know
that you are expected to do a complete and thorough examination before making
a decision to withdraw treatment.
What do you do?