Neurosurgical Decision-Making and Ethical Considerations in the Treatment of Traumatic Brain Injury

Abstract

Globally, disparities in the availability of surgical care are prevalent, and for specialty care such as neurosurgery, services are typically scarce to non-existent. In low-and-middle-income countries, most medical centers have limited resources and are not equipped to handle neurosurgical emergencies. Within the field of global neurosurgery, there has been a push to incorporate advanced technologies such as predictive modeling to facilitate triage and neurosurgical care decision-making. However, to successfully implement such technologies, it is vital to consider the ethical framework within which neurosurgical care decisions are made and how ethical challenges inform decision-making. The objective of this study is to determine whether the potential ethical challenges that neurosurgical care providers encounter are differentially important to decision-making. This study utilizes a rank-order survey to evaluate surgical risk tolerance, the relative importance of several patient-level and system-level factors to the decision to offer surgery, and perceptions of the fairness of several resource-allocation principles when surgery cannot be offered to all patients in need. Further, we assessed whether geographic, demographic, cultural, and institutional characteristics and utilitarian ethical orientation differentially impact these aspects of decision-making. Based on the results, it does seem as though there is a differential impact of ethical challenges on decision-making. In conclusion, this data will allow identification of key commonalities and differences in approaches to neurosurgical decision-making across practice settings, which will potentially facilitate ethically responsible, cross-cultural collaborations and implementations of neurosurgical decision support tools.