Neuropalliative Care (DRAFT)

Neuropalliative care encompasses disorders of consciousness, cognitive impairment, trauma, and other conditions. Each prompts specific ethical considerations, such as the often shifting values (and even personalities) of patients with dementia, forcing one to determine whether previously expressed wishes are determinative. Patients with amyotrophic lateral sclerosis maintain cognition long after motor failure, and the predicable trajectory makes possible specific advance care planning. Patients who have suffered acute spinal cord injury may initially demand withdrawal of life sustaining medical treatment, yet studies have shown a significant proportion eventually achieve a quality of life acceptable to them. And patients who have suffered a stroke often recover significant function, thus making early limitation of treatment a potential “self-fulfilling prophecy.”