• Ivo S Muskens, Saksham Gupta, Faith C Robertson, Wouter A Moojen, Angelos G Kolias, Wilco C Peul, and Broekman Marike L D MLD Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands; Department of Neurosurgery, Brigham and Women's Hospital, H.
• Department of Preventative Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA; Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands; Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
• World Neurosurg. 2019 May 1; 125: e336-e340.

AbstractNeurosurgical interventions frequently occur in an emergency setting. In this setting, patients often have impaired consciousness and are unable to directly express their values and wishes regarding their treatment. The limited time available for clinical decision making has great ethical implications, as the informed consent procedure may become compromised. The ethical situation may be further challenged by different views between the patient, family members, and the neurosurgeon; the presence of advance directives; the use of an innovative procedure; or if the procedure is part of a research project. This moral opinion piece presents the implications of time constraints and a lack of patient capacity for autonomous decision making in emergency neurosurgical situations. Potential solutions to these challenges are presented that may help to improve ethical patient management in emergency settings. Emergency neurosurgery challenges the respect of autonomy of the patient. The outcome in most scenarios will rely on the neurosurgeon acting in a professional way to manage each unique situation in an ethically sound manner.Copyright © 2019 Elsevier Inc. All rights reserved.

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