Electroencephalographic monitoring provides critical diagnostic and management information about patients with epilepsy and seizure mimics. Admission to an epilepsy monitoring unit (EMU) is the gold standard for such monitoring in major medical facilities worldwide. In many countries, access can be challenged by limited resources compared to need. Today, triaging admission to such units is generally approached by unwritten protocols that vary by institution. In the absence of explicit guidance, decisions can be ethically taxing and are easy to challenge. In an effort to address this gap, we propose a two-component approach to EMU triage that takes into account the unique landscape of epilepsy monitoring informed by triage literature from other areas of medicine. Through the strategic component, we focus on the EMU wait list management infrastructure at the institutional level. Through the principled component, we apply a combination of the ethical principles of prioritarianism, utilitarianism and justice to triage; and we use individual case examples to illustrate how they apply. The effective implementation of this approach to specific epilepsy centres will need to be customised to the nuances of different settings, including diverse practice patterns, patient populations and constraints on resource distribution, but the conceptual consolidation of its components can alleviate some of the pressures imposed by the complex decisions involved in EMU triage.
- epilepsy monitoring unit
- resource allocation
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Contributors JR: conceptualised the work, developed the model, wrote and edited the manuscript. CTH: conferred on the model, contributed to and edited the manuscript. PJM: conferred on the model, contributed to and edited the manuscript. JI: provided overall supervision of the project, conferred on the model, contributed to and edited the manuscript.
Funding This work was supported by the National Institutes of Health (NIH) BRAIN Initiative on Neuroethics (RF1 # MH117805 01; JI, principal investigator; PJM, coprincipal investigator). At the time of the project, JI held the Canada Research Chair Program in Neuroethics (2007-2021), and PJM held the Alcan Chair in Neurosciences at UBC. This project was undertaken by JR as part of a Neurologist-In-Training Clinical Ethics Elective (NITCEE) sponsored by the American Academy of Neurology.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.