Objective:

This study aimed to assess the most frequent ethics topics in clinical ethics consultations (CEC) for patients with primary neurologic and neurosurgical diagnoses.

Background:

Since the American Medical Association and the American Hospital Association endorsement of CEC committees in 1984, such committees have become common and now exist in over 90% of United States hospitals. Despite modest increases in empirical data on CEC history and ethics themes, few studies have focused specifically on the complexity often found in neurologic cases. One 2008 retrospective review (n=49) focused on neurologic CEC found death by neurologic criteria (DNC) and futility the most common topics. A 2021 study out of Germany (n=27) focused only on informed consent, decision-making capacity, and surrogate decision-making in neurologic CEC.

Design/Methods:

The American Society for Bioethics and Humanities’ Healthcare Ethics Consultant-Certified handbook was used to formulate an a priori codebook of clinical ethics topics. Using a content analysis model, the codebook was applied to written CEC chart notes from 2013-2023 at a tertiary academic medical center in the Mid-Atlantic United States. Reliability was assessed through inter-rater agreement.

Results:

Seventy-one eligible consults were identified. In preliminary analysis, the most common primary ethics topic was surrogate decision-making, comprising 24% of consults. Informed consent (14%), balancing ethical principles (11%), and pediatric-specific decision-making (10%) were other common ethics topics. Notably, DNC was not a primary ethical concern for any consult, and futility accounted for only 3% of CEC.

Conclusions:

Common ethical issues in neurology are evolving over time with topics relating to respect for persons becoming more prevalent in recent analyses compared to futility- and DNC-prominent results in older studies. Further research is needed to compare CEC across all specialties to neurologic-specific CEC. Knowledge of which ethical issues arise most in neurology and neurosurgery can help inform educational efforts to better equip providers for ethically complex cases.