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Treatment decisions and changing selves
  1. Rebecca Dresser
  1. Correspondence to Professor Rebecca Dresser, Washington University, Law School, One Brookings Drive, Box 1120, St. Louis, MO 63130, USA; dresser{at}wulaw.wustl.edu

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Treatment decisions are difficult when outcomes are highly uncertain. Many life-saving interventions produce a variety of outcomes and no one can predict precisely where a particular patient will end up. It is also impossible to predict exactly how patients will evaluate outcomes that leave them with fewer abilities than they once had.

In Long-term survival with unfavourable outcome: a qualitative and ethical analysis, Stephen Honeybul and colleagues present some surprising information about patients’ adaptive capacities.1 The analysis describes the results of semistructured interviews with patients who had life-saving surgery (decompressive craniectomy) following severe brain trauma. Patients suffering traumatic brain injury are incapacitated, and so the surgery decision must be made by clinicians and family members.

Decompressive craniectomy yields a range of outcomes, including full recovery, mild, moderate or severe disability, and death. The authors interviewed patients in the severe disability outcome group. In all, 11 of 13 patients said that they would have consented to the surgery even if they had known its outcome. The patients expressing this view were either fully or substantially dependent on others for care. None were able to engage in activities like shopping and riding public transport on their own. Despite their limitations, they approved …

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