Ethical Issues In Neurology

Advances in our understanding of the brain and rapid advances in the medical practice of neurology are creating questions and concerns from an ethical and legal perspective. Ethical and Legal Issues in Neurology provides a detailed review of various general aspects of neuroethics, and contains chapters dealing with a vast array of specific issues such as the role of religion, the ethics of invasive neuroscience research, and the impact of potential misconduct in neurologic practice. The book focuses particular attention on problems related to palliative care, euthanasia, dementia, and neurogenetic disorders, and concludes with examinations of consciousness, personal identity, and the definition of death. This volume focuses on practices not only in North America but also in Europe and the developing world. It is a useful resource for all neuroscience and neurology professionals, researchers, students, scholars, practicing clinical neurologists, mental health professionals, and psychiatrists. A comprehensive introduction and reference on neuroethics Includes coverage of how best to understand the ethics and legal aspects of dementia, palliative care, euthanasia and neurogenetic disorders Brings clarity to issues regarding ethics and legal responsibilities in the age of rapidly evolving brain science and related clinical practice

Written by an eminent authority from the American Academy of Neurology's Committee on Ethics, Law, and Humanities, this book is an excellent text for all clinicians interested in ethical decision-making. The book features outstanding presentations on dying and palliative care, physician-assisted suicide and voluntary active euthanasia, medical futility, and the relationship between ethics and the law. New chapters in this edition discuss how clinicians resolve ethical dilemmas in practice and explore ethical issues in neuroscience research. Other highlights include updated material on palliative sedation, advance directives, ICU withdrawal of life-sustaining therapy, gene therapy, the very-low-birth-weight premature infant, the developmentally disabled patient, informed consent, organizational ethics, brain death controversies, and fMRI and PET studies relating to persistent vegetative state.

Almost every neurologist encounters ethical issues daily. This exemplary ethics text meets the needs of students, residents, fellows, and practicing neurologists who want an accessible case-based text for learning, and it meets the needs of directors of medical student clerkships and residency programs in neurology who want an accessible case-based text for teaching. The book’s case-based approach places key ethical principles into a practical, real-world context to aid in decision-making. Each chapter includes an outstanding array of learning features includes Learning Objectives, Clinical Vignettes, Questions to guide self-study and group discussions, Key Points, Key Words, Suggestions for Further Reading, and more. Clinical Pragmatism model helps readers analyze ethical issues in a clinical context. Practical Ethics in Clinical Neurology is a companion to the most highly respected ethics text in neurology and neurosurgery, Bernat's Ethical Issues in Neurology, 3rd edition.

An international team of recognized authorities offer a collection of thought provoking essays on ethical questions often faced by neurologists in clinical practice.

Patients in coma, vegetative state/unresponsive wakefulness syndrome, and in minimally conscious states pose medical, scientific, and ethical challenges. As patients with disorders of consciousness are by definition unable to communicate, the assessment of pain, quality of life, and end-of-life preferences in these conditions can only be approached by adopting a third-person perspective. Surveys of healthcare workers’ attitudes towards pain and end of life in disorders of consciousness shed light on the background of clinical reality, where no standard medical-legal framework is widely accepted. On the other hand, patients with locked-in syndrome, who are severely paralyzed but fully conscious, can inform about subjective quality of life in serious disability and help us to understand better the underlying factors influencing happiness in disease. In the medico-legal arena, such ethical issues may be resolved by previously drafted advance directives and, when absent, by surrogate representation. Lately, functional medical imaging and electrophysiology provide alternative means to communicate with these challenging patients and will potentially mediate to extract responses of medical-ethical content. Eventually, the clinical translation of these advanced technologies in the medical routine is of paramount importance for the promotion of medical management of these challenging patients.

Caring for persons with Alzheimer’s disease presents neurologists with ethical challenges. Some of these, such as end-of-life care or research participation, are well known and have significant overlap with challenges in other areas of medicine or other neurologic diseases, such as cancer or traumatic brain injury, while others, such as the rise of biomarker-based diagnostics, are more novel and reflect the impact of developments in the science and clinical care of Alzheimer’s disease. A thoughtful and systematic approach to these challenges, from the preclinical to the late symptomatic stage of this disease, is required and will help clinicians be better advocates and stewards of their patients. This chapter addresses a number of the most pressing ethical problems facing patients, caregivers, and clinicians during this disease, including early and presymptomatic testing, assessment of decision-making capacity for treatment or research participation, restriction of driving, remote monitoring, assisted suicide, and treatment of disruptive behaviors.

Behavioral neuroscience encompasses the disciplines of neurobiology and psychology to study mechanisms of behavior. This volume provides a contemporary overview of the current state of how ethics informs behavioral neuroscience research. There is dual emphasis on ethical challenges in experimental animal approaches and in clinical and nonclinical research involving human participants.

Clinical ethics is the application of ethical theories, principles, rules, and guidelines to clinical situations in medicine. Therefore, clinical ethics is analogous to clinical medicine in that general principles and concepts must be applied intelligently and thoughtfully to unique clinical circumstances. The three major ethical theories are consequentialism, whereby the consequences of an action determine whether it is ethical; deontology, whereby to be ethical is to do one’s duty, and virtue ethics, whereby ethics is a matter of cultivating appropriate virtues. In the real world of medicine, most people find that all three perspectives offer useful insights and are complementary rather than contradictory. The most common approach to clinical ethical analysis is principlism. According to principlism, the medical practitioner must attempt to uphold four important principles: respect for patient autonomy, beneficence, nonmaleficence, and justice. When these principles conflict, resolving them depends on the details of the case. Alternative approaches to medical ethics, including the primacy of beneficence, care-based ethics, feminist ethics, and narrative ethics, help to define the limitations of principlism and provide a broader perspective on medical ethics.