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life-sustaining treatment is continued, the patient may survive with unacceptably poor neurological prospects, but if withdrawn a patient who could have recovered may die.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life-sustaining treatment is continued, the patient may survive with unacceptably poor neurological prospects, but if withdrawn a patient who could have recovered may die.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 -