Medical Futility at the American Academy of Neurology Conference

Today is the start of the 2013 Annual Meeting of the American Academy of Neurology.  While there are, of course, ethics sessions on topics such a determination of brain death, there are two that specifically cover medical futility.



Ethical Dilemmas in the ICU

• Program Description:  Neurologists frequently encounter ethical dilemmas when caring for patients with critical brain damage. These clinical problems have also acquired enormous public exposure through the media. In this program, faculty will discuss crucial topics, such as withdrawal of life-sustaining measures and the challenges of communicating with families of severely ill neurologic patients, using practical presentations and interaction with the participants.

• Upon Completion:  Participants should be able to improve their understanding of the concept of futility of care; learn the reach and limits of prognostication in patients with critical brain injury; recognize the risk of creating a self-fulfilling prophecy when predicting a poor prognosis; and acquire new skills to communicate with families when discussing possible withholding or withdrawing of life-sustaining measures.

• Faculty:  Claude Hemphill, III, MD, FAAN, San Francisco (Withdrawal of Life Support: Self-fulfilling Prophecy); Eelco F. M. Wijdicks, MD, FAAN, Rochester, MN (The Family Conference)

Ethics, Clinical Practice, and Challenges in Neurogeriatric Care for the 21st Century

• Program Description:  Faculty will describe and discuss ethical issues related to providing care for the rapidly increasing number of geriatric patients afflicted with incapacitating neurologic disease. The vital role of the neurologist in providing ethically based care for patients with end-stage neurologic disease will be emphasized. Ethical issues related to the practical management of patients with dementia will be discussed. The patient-physician relationship, informed consent and determining decision-making capacity of patients with dementia will be discussed. Pros and cons of obtaining genetic testing for individuals at risk for developing dementia will be discussed. Medical futility as well as evidence-based guidelines appropriate for providing optimal palliative and end-of-life care for patients with end-stage neurologic disorders will be discussed.

• Upon Completion:  Participants should have an increased ability to solve medical-ethical dilemmas confronting the neurologist in providing comprehensive ethical care for geriatric patients with life-limiting neurologic disease; have an enhanced appreciation for obtaining informed consent, respecting patient autonomy, and determining medical decision-making capacity and competence, and the role of advance directives for the patient with dementia; be able to discuss ethical dimensions of diagnostic testing of asymptomatic individuals at risk for developing dementia; and have an enhanced knowledge of perceived medical futility, as well as the evidence base for providing optimal palliative and end-of-life care.

• Faculty:  James L. Bernat, MD, FAAN, Lebanon, NH (The Patient with Dementia: The Patient-Physician Relationship, Disclosing the Diagnosis, Consent, and Advance Directives); Eran P. Klein, MD, PhD, Portland, OR (Testing in Presymptomatic Individuals At-Risk for Neurological Disease); Lawrence J. Schneiderman, MD, La Jolla, CA (Medical Futility); Jerome E. Kurent, MD, MPH, FAAN, Charleston, SC (Ethical Clinical Decision Making: Neuropalliative and End-of-life Care for Patients with End-stage Neurological Disease)