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Semin Neurol 2023; 43(05): 758-767
DOI: 10.1055/s-0043-1775597
Review Article

Ethical Considerations in Neuroprognostication Following Acute Brain Injury

India A. Lissak
1   Department of Neurology, Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
,
Brian L. Edlow
1   Department of Neurology, Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
2   Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts
,
Eric Rosenthal
1   Department of Neurology, Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
,
Michael J. Young
1   Department of Neurology, Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
› Author Affiliations Funding Supported by the NIH BRAIN Initiative (F32MH123001), NIH Director's Office (DP2HD101400), Tiny Blue Dot Foundation, and American Academy of Neurology (Palatucci Advocacy Grant). The funders had no role in the design, analysis, preparation, review, approval, or decision to submit this manuscript for publication.
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Abstract

Neuroprognostication following acute brain injury (ABI) is a complex process that involves integrating vast amounts of information to predict a patient's likely trajectory of neurologic recovery. In this setting, critically evaluating salient ethical questions is imperative, and the implications often inform high-stakes conversations about the continuation, limitation, or withdrawal of life-sustaining therapy. While neuroprognostication is central to these clinical “life-or-death” decisions, the ethical underpinnings of neuroprognostication itself have been underexplored for patients with ABI. In this article, we discuss the ethical challenges of individualized neuroprognostication including parsing and communicating its inherent uncertainty to surrogate decision-makers. We also explore the population-based ethical considerations that arise in the context of heterogenous prognostication practices. Finally, we examine the emergence of artificial intelligence-aided neuroprognostication, proposing an ethical framework relevant to both modern and longstanding prognostic tools.

Keywords

Neuroprognostication - brain injury - disorders of consciousness - neuroethics - coma - artificial intelligence


Publication History

Article published online:
06 October 2023

© 2023. Thieme. All rights reserved.

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