Neuromonitoring to avoid euthanasia in a quadriplegic patient

Background: Under very limited circumstances euthanasia can be performed in Belgium since 2002 (Verwilghen, 2012). If a patient has medical condition with no hope on improvement, with physical and/or psychological suffering, he can ask for terminating his life. The written demand is on voluntary bases, well considered, repeated and was not induced due to external pressure from other people. Neuromonitoring has been used in spine surgery during the last four decades. (Lall, et al., 2012) (Gonzales, Jeyanandarajan, Hansen, Zada, & Hsieh, 2009) With the development of new modalities, new applications were introduced in spine surgery in order to avoid neurological damage during surgical procedures. Method: A patient with a partial recovered ASIA A C7 quadriplegia suffering from wounds caused by his spinal instrumentation had intraoperative neuromonitoring. In case he became dependent for his personal care, he wanted to have euthanasia executed on him. Conclusion: So far there is no literature on the use of neuromonitoring to avoid euthanasia in cases where spinal surgery is needed, but surgery has an inherent risk of causing damage to nerval structures, which can cause loss of recovered nerve function after spinal cord injury. This potential loss of independence was an unbearable physical and psychological suffering the patient would not want to go through again. By using neuromonitoring, the key muscles were observed during the surgery. No neurological events were seen during the prodecure. He had some general weakness after the surgery but kept his autonomy, so no euthanasia was needed.