TREATMENT OF PATIENTS WITH BASILAR OCCLUSION AND LOCKED-IN-SYNDROME -AN ETHICAL DILEMMA

Decisions regarding the extent of treatment of severely ill patients c an be an ethical dilemma when life-prolonging intensive care contradic ts the goal of avoiding unnecessary suffering on the part of the patie nt. Here we present the results of a written survey of physicians on n eurological intensive care units in Germany regarding the treatment of patients with basilar artery thrombosis and locked-in syndrome. 52% o f the 93 physicians who replied advocated not treating severe infectio ns with antibiotics. 38% were in favor of stopping intensive care. In contrast, 55% recommended intubating the patient in the presence of sw allowing disturbances and imminent aspiration. 58% were in favor of di scussing these problems in detail with the patient,and 87% advocated d iscussing them with relatives. Nearly all physicians (97%) recommended using adquate amounts of opiates and benzodiazepines. In very rare ca ses, 99% would agree to the use of passive ethanasia and 19% to active euthanasia. These findings illustrate the current disagreement on som e of the important treatment decisions among physicians on neurologica l intensive care units. An open exchange of views on these questions c ould facilitate the appropriate consideration of ethical matters in th e treatment of these patients.