TY - JOUR T1 - Ethical considerations for performing decompressive craniectomy as a life-saving intervention for severe traumatic brain injury JF - Journal of Medical Ethics JO - J Med Ethics SP - 657 LP - 661 DO - 10.1136/medethics-2012-100672 VL - 38 IS - 11 AU - Stephen Honeybul AU - Grant Gillett AU - Kwok Ho AU - Christopher Lind Y1 - 2012/11/01 UR - http://jme.bmj.com/content/38/11/657.abstract N2 - In all fields of clinical medicine, there is an increasing awareness that outcome must be assessed in terms of quality of life and cost effectiveness, rather than merely length of survival. This is especially the case when considering decompressive craniectomy for severe traumatic brain injury. The procedure itself is technically straightforward and involves temporarily removing a large section of the skull vault in order to provide extra space into which the injured brain can expand. A number of studies have demonstrated many patients going on to make a good long-term functional recovery, however, this is not always the case and a significant number survive but are left with severe neurocognitive impairment. Unfortunately, many of these patients are young adults who were previously fit and well and are, therefore, likely to spend many years in a condition that they may feel to be unacceptable, and this raises a number of ethical issues regarding consent and resource allocation. In an attempt to address these issues, we have used the analytical framework proposed by Jonsen, that requires systematic consideration of medical indications, patient preferences, quality of life and contextual features. ER -