Chasing Certainty After Cardiac Arrest: Can a Technological Innovation Solve a Moral Dilemma?
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Chasing Certainty After Cardiac Arrest : Can a Technological Innovation Solve a Moral Dilemma? / Mertens, Mayli; van Til, Janine; Bouwers-Beens, Eline; Boenink, Marianne.
In: Neuroethics, Vol. 14, 2021, p. 541–559.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Chasing Certainty After Cardiac Arrest
T2 - Can a Technological Innovation Solve a Moral Dilemma?
AU - Mertens, Mayli
AU - van Til, Janine
AU - Bouwers-Beens, Eline
AU - Boenink, Marianne
PY - 2021
Y1 - 2021
N2 - When information on a coma patient's expected outcome is uncertain, a moral dilemma arises in clinical practice: if life-sustaining treatment is continued, the patient may survive with unacceptably poor neurological prospects, but if withdrawn a patient who could have recovered may die. Continuous electroencephalogram-monitoring (cEEG) is expected to substantially improve neuroprognostication for patients in coma after cardiac arrest. This raises expectations that decisions whether or not to withdraw will become easier. This paper investigates that expectation, exploring cEEG's impacts when it becomes part of a socio-technical network in an Intensive Care Unit (ICU). Based on observations in two ICUs in the Netherlands and one in the USA that had cEEG implemented for research, we interviewed 25 family members, healthcare professionals, and surviving patients. The analysis focuses on (a) the way patient outcomes are constructed, (b) the kind of decision support these outcomes provide, and (c) how cEEG affects communication between professionals and relatives. We argue that cEEG can take away or decrease the intensity of the dilemma in some cases, while increasing uncertainty for others. It also raises new concerns. Since its actual impacts furthermore hinge on how cEEG is designed and implemented, we end with recommendations for ensuring responsible development and implementation.
AB - When information on a coma patient's expected outcome is uncertain, a moral dilemma arises in clinical practice: if life-sustaining treatment is continued, the patient may survive with unacceptably poor neurological prospects, but if withdrawn a patient who could have recovered may die. Continuous electroencephalogram-monitoring (cEEG) is expected to substantially improve neuroprognostication for patients in coma after cardiac arrest. This raises expectations that decisions whether or not to withdraw will become easier. This paper investigates that expectation, exploring cEEG's impacts when it becomes part of a socio-technical network in an Intensive Care Unit (ICU). Based on observations in two ICUs in the Netherlands and one in the USA that had cEEG implemented for research, we interviewed 25 family members, healthcare professionals, and surviving patients. The analysis focuses on (a) the way patient outcomes are constructed, (b) the kind of decision support these outcomes provide, and (c) how cEEG affects communication between professionals and relatives. We argue that cEEG can take away or decrease the intensity of the dilemma in some cases, while increasing uncertainty for others. It also raises new concerns. Since its actual impacts furthermore hinge on how cEEG is designed and implemented, we end with recommendations for ensuring responsible development and implementation.
KW - Prognostic uncertainty
KW - Technological innovation
KW - cEEG
KW - Performativity
KW - Postanoxic coma
KW - Decision support
KW - Clinical dilemma
KW - SELF-FULFILLING PROPHECY
KW - LETTING DIE
KW - POSTANOXIC COMA
KW - PREDICTION
KW - RESUSCITATION
KW - RELIABILITY
KW - PERFORMANCE
KW - HYPOTHERMIA
KW - PROGNOSIS
U2 - 10.1007/s12152-021-09473-9
DO - 10.1007/s12152-021-09473-9
M3 - Journal article
VL - 14
SP - 541
EP - 559
JO - Neuroethics
JF - Neuroethics
SN - 1874-5490
ER -
ID: 275817869