Stanford Center for
Biomedical Ethics

Specialty training and physician decision-making in the care of critically ill neurologic patients

FUNDER: Social Sciences and Humanities Research Council

DATES: 08/01/05-06/01/06

Traditionally, intensive care was directed at patients suffering from severe sepsis or respiratory problems. Currently, a third of patients admitted to the intensive Care Unit (ICU) have neurological syndromes detrimental to their outcomes, and neurological complications double both the length of stay in hospital and the likelihood of death in ICU patients. Research and technological advancement for ICU patients with neurological syndromes have led to the training of neurologists in intensive care since the early 80’s. The special training of intensivists focused on neurological outcome – “neurointensivists” may introduce a new vision of critical care to the ICU setting, thereby improving patient care but adding new layers of medical and human complexity. These differing backgrounds and experience may lead to distinct visions of outcome and quality of life. In critical situations, the existence of distinct views may complicate communication and yield diverging opinions about ethical issues in end-of-life decision making. Our goal therefore is to examine these differences, and identify related challenges in the treatment of neurocritical care patients in the medical ICU.

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