Neurotrauma and the RUB: where tragedy meets ethics and science. Issue 12 (18th September 2010)

• Record Type: Journal Article
• Authors: Gillett, G R; Honeybul, S; Ho, K M; Lind, C R P
• Is Part Of: Journal of medical ethics. Volume 36:Issue 12(2010)
• Page Start: 727
• Page End: 730
• Publication Date: 2010-09-18
• Subjects: Risk of unacceptable badness -- decision making -- outcomes -- neurotrauma -- quality/value of life/personhood -- informed consent -- allocation of health care resources -- general; Medical ethics -- Periodicals; 174.2
• DOI: 10.1136/jme.2010.037424
• Languages: English
• ISSNs: 0306-6800

Abstract

Abstract : Decompressive craniectomy is a technically straightforward procedure whereby a large section of the cranium is temporarily removed in cases where the intracranial pressure is dangerously high. While its use has been described for a number of conditions, it is increasingly used in the context of severe head injury. As the use of the procedure increases, a significant number of patients may survive a severe head injury who otherwise would have died. Unfortunately some of these patients will be left severely disabled; a condition likened to the RUB, an acronym for the Risk of Unacceptable Badness. Until recently it has been difficult to predict this outcome, however an accurate prediction model has been developed and this has been applied to a large cohort of patients in Western Australia. It is possible to compare the predicted outcome with the observed outcome at 18 months within this cohort. By using predicted and observed outcome data this paper considers the ethical implications in three cases of differing severity of head injury in view of the fact that it is possible to calculate the RUB for each case.