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Neurotrauma and the rule of rescue
  1. S Honeybul1,
  2. G R Gillett2,3,
  3. K M Ho4,
  4. C R P Lind1,5
  1. 1Department of Neurosurgery, Sir Charles Gairdner Hospital and Royal Perth Hospital, Perth, Western Australia, Australia
  2. 2Dunedin Hospital, University of Otago, Dunedin, New Zealand
  3. 3Otago Bioethics Centre, University of Otago, Dunedin, New Zealand
  4. 4Department of Intensive Care Medicine and School of Population Health, University of Western Australia, Perth, Western Australia, Australia
  5. 5School of Surgery, University of Western Australia, Perth, Western Australia, Australia
  1. Correspondence to S Honeybul, Sir Charles Gairdner Hospital, Perth, WA 6009, Australia; stephen.honeybul{at}health.wa.gov.au

Abstract

The rule of rescue describes the powerful human proclivity to rescue identified endangered lives, regardless of cost or risk. Deciding whether or not to perform a decompressive craniectomy as a life-saving or ‘rescue’ procedure for a young person with a severe traumatic brain injury provides a good example of the ethical tensions that occur in these situations. Unfortunately, there comes a point when the primary brain injury is so severe that if the patient survives they are likely to remain severely disabled and fully dependent. The health resource implications of this outcome are significant. By using a web-based outcome prediction model this study compares the long-term outcome and designation of two groups of patients. One group had a very severe injury as adjudged by the model and the other group a less severe injury. At 18 month follow-up there were significant differences in outcome and healthcare requirements. This raises important ethical issues when considering life-saving but non-restorative surgical intervention. The discussion about realistic outcome cannot be dichotomised into simply life or death so that the outcome for the patient must enter the equation. As in other ‘rescue situations’, the utility of the procedure cannot be rationalised on a mere cost–benefit analysis. A compromise has to be reached to determine at what point either the likely outcome would be unacceptable to the person on whom the procedure is being performed or the social utility gained from the rule of rescue intervention fails to justify the utilitarian value and justice of equitable resource allocation.

  • Rule of rescue
  • decision making
  • outcomes
  • neurotrauma
  • clinical ethics
  • surgery
  • end of life care
  • surgery
  • status of embryo
  • professional discipline
  • philosophy and psychiatry

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Footnotes

  • Competing interests None.

  • Ethics approval This study was approved by Sir Charles Gairdner Hospital human research ethics committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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