Letter by Woodworth and Simard Regarding Article, “Outcome Following Decompressive Hemicraniectomy for Malignant Cerebral Infarction: Ethical Considerations”

We read with interest the excellent article by Honeybul et al1 wherein important ethical issues are raised about decompressive craniectomy.Heroic, potentially risky surgical interventions are increasingly being used for patients with terminal or life-altering conditions, such as hemispheric stroke and recurrent glioblastoma. Increasing numbers of patients and their families are forced to confront the idea of surgery near end-of-life, typically with little preparation. This compels surgeons to act as intermediary advisors—helping to choose between a major intervention aimed at a hoped for recovery, versus letting go and allowing nature to take its course. In such cases, medical decision-making is affected critically by numerous factors, including rapid advances in new technologies, malpractice concerns, and differences in culture and personality.Medical advances are occurring at a blistering pace, not least of all in neurosurgery. Improvements in the management of heretofore fatal conditions, combined …