Ethical dilemmas in the neurologic ICU: Withdrawing life-support measures after devastating brain injury

Withholding aggressive treatments and withdrawing life-support measures are common in patients with devastating acute brain injury. Yet, guiding families who make these decisions is often very challenging. Ethical questions arise when the level of care requested by the family does not agree with the prognosis estimated by the clinician. There is also concern that communicating a pessimistic prognosis to families might produce a self-fulfilling prophecy by leading to restriction of intensive care. Understanding the limitations of our prognostic information and the factors that influence the decision to withhold or withdraw care in the neurologic intensive care unit is crucial to ensure honest and effective communication with families.