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Ethics of transitioning from curative care to palliative care : potential conflicts of interest using the example of neurosurgery
Article
Objective: Neurosurgical conditions are often incurable and lead to disability, severe physical symptoms, and distress for patients and families. Neurosurgeons may be responsible for transitioning management from curative to palliative. We sought to analyze the ethics of transitioning care from curative to palliative in patients in one's own specialty.
Methods: This is a case-based narrative review. PubMed and Google Scholar were searched with no restrictions on date. Studies relevant to the topic were included.
Results: We provide an introductory case. Then, we define the curative and palliative neurosurgical treatment paradigms, clarify the concept of transition of care from curative to palliative, and contrast generalist and specialist palliative care. Next, we provide an overview of core ethical principles. Then, we describe key considerations involved in transitioning patients from curative to palliative in one's own specialty, namely knowledge, communication, uncertainty, and futility. We then provide an analysis of the introductory case, highlighting the conflict of interest inherent in the transition.
Conclusion: We conclude that it is acceptable for neurosurgeons and other specialists with adequate palliative care training to manage the transition in most cases, preferably as part of multidisciplinary care teams. While we discuss the example of neurosurgery in this manuscript, we emphasize that this analysis applies to other specialties where care transitions from curative to palliative intent occur. Across specialties, patient preferences and values are foundational in the timing and specifics of this transition.
http://dx.doi.org/10.1016/j.wneu.2022.10.003
Voir la revue «World neurosurgery, 168»
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