Primo non nocere or maximum survival in grade 2 gliomas? A medical ethical question
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Primo non nocere or maximum survival in grade 2 gliomas? A medical ethical question. / Brennum, Jannick; Maier, Carolina Magdalene; Almdal, Kerstin; Engelmann, Christina Malling ; Gjerris, Mickey.
I: Acta Neurochirurgica, Bind 157, Nr. 2, 02.2015, s. 155-164.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Primo non nocere or maximum survival in grade 2 gliomas? A medical ethical question
AU - Brennum, Jannick
AU - Maier, Carolina Magdalene
AU - Almdal, Kerstin
AU - Engelmann, Christina Malling
AU - Gjerris, Mickey
N1 - Published online 21 Dec 2014
PY - 2015/2
Y1 - 2015/2
N2 - BackgroundMaximum safe resection is the “gold standard” in surgical treatment of grade 2 gliomas (G2Gs), aiming to achieve maximal survival benefit with minimal risk of functional deficit.ObjectiveTo investigate the attitude of patients and experts towards more extensive surgery with a trade-off between neurological function and survival time.MethodsEight patients and seven experts participated in semi-structured focus group interviews.ResultsBoth patients and experts accepted the premise of balancing neurological function versus longevity. Some patients would accept an increased risk of permanent neurological deficits in order to obtain a chance of increased survival. There was a significant variance in what constituted “quality of life” both between patients and for the individual patient over time.ConclusionsIn important life-changing decisions there is no “one size fits all”. We find that it is ethically acceptable to offer more extensive surgery than is possible within the concept of maximal safe surgery as a treatment option, when balancing the principles of beneficence, non-maleficience, autonomy and justice supports the decision. At the same time it must be remembered that even when the patients have made a well-informed decision, some will regret it. In that situation it will be our job as healthcare professionals to support them and help carry some of this burden.
AB - BackgroundMaximum safe resection is the “gold standard” in surgical treatment of grade 2 gliomas (G2Gs), aiming to achieve maximal survival benefit with minimal risk of functional deficit.ObjectiveTo investigate the attitude of patients and experts towards more extensive surgery with a trade-off between neurological function and survival time.MethodsEight patients and seven experts participated in semi-structured focus group interviews.ResultsBoth patients and experts accepted the premise of balancing neurological function versus longevity. Some patients would accept an increased risk of permanent neurological deficits in order to obtain a chance of increased survival. There was a significant variance in what constituted “quality of life” both between patients and for the individual patient over time.ConclusionsIn important life-changing decisions there is no “one size fits all”. We find that it is ethically acceptable to offer more extensive surgery than is possible within the concept of maximal safe surgery as a treatment option, when balancing the principles of beneficence, non-maleficience, autonomy and justice supports the decision. At the same time it must be remembered that even when the patients have made a well-informed decision, some will regret it. In that situation it will be our job as healthcare professionals to support them and help carry some of this burden.
U2 - 10.1007/s00701-014-2304-5
DO - 10.1007/s00701-014-2304-5
M3 - Journal article
VL - 157
SP - 155
EP - 164
JO - Acta Neurochirurgica
JF - Acta Neurochirurgica
SN - 0001-6268
IS - 2
ER -
ID: 132591441