Article Text

Download PDFPDF
Strategic and principled approach to the ethical challenges of epilepsy monitoring unit triage
  1. Jason Randhawa1,2,
  2. Chantelle T Hrazdil2,
  3. Patrick J McDonald1,3,
  4. Judy Illes1,2
  1. 1Neuroethics Canada, Division of Neurology, Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
  2. 2Division of Neurology, Department of Medicine, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
  3. 3Division of Neurosurgery, Department of Surgery, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
  1. Correspondence to Professor Judy Illes, Neuroethics Canada, Division of Neurology, Department of Medicine, The University of British Columbia, Vancouver, BC V6T 2B5, Canada; jilles{at}mail.ubc.ca; Dr Jason Randhawa, Dartmouth-Hitchcock Medical Centre, Lebanon, New Hampshire, USA; Jason.Randhawa{at}hitchcock.org

Abstract

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.

  • neuroethics
  • ethics
  • epilepsy
  • epilepsy monitoring unit
  • triage
  • resource allocation

Data availability statement

There are no data in this work.

Statistics from Altmetric.com

Footnotes

  • 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.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Other content recommended for you