Assistant Professor The Ohio State University Columbus, Ohio, United States
Case Diagnosis: Disorders of consciousness (DoC) encompass a spectrum of neurological states in which there is significant impairment of a person's awareness of self and environment, often caused by a traumatic brain injury (TBI). Management of patients with DoC raises significant ethical questions regarding treatment decisions made by both families and providers. This case report highlights an unusual situation of a pregnant patient diagnosed with severe TBI and DoC, and the ethical decision regarding termination of her pregnancy.
Case Description: A 26-year-old female who was 8 weeks pregnant presented as an unrestrained driver in a motor vehicle collision. MRI Brain showed evidence of diffuse axonal injury (stage III). She was in a vegetative state with periods of eye opening and sleep-wake cycles but lacked purposeful interactions. Her decision makers (parents and fiancé) requested termination of pregnancy to focus on patient’s recovery from this devastating neurological injury.
Discussions: With the need for balance between the best interests of both mother and fetus, multidisciplinary discussion occurred regarding the difficult ethical decision of termination of pregnancy. The goals of care were discussed among neurocritical care, ethics, OB/GYN, and the hospital legal teams. Given the patient's recovery course would take months, the impact of pregnancy physiology on her current condition is unclear. Maternal Fetal Medicine determined that continuing pregnancy would put this patient at significantly increased risk for maternal death in the setting of disorders of consciousness. She underwent termination of pregnancy via dilation and curettage.
Conclusions: Ethical considerations are crucial aspects of management of DoC patients, especially when the likelihood of recovery is uncertain. Families and healthcare providers often face difficult and complex decisions as these situations raise questions about autonomy, quality of life, and the appropriate course of medical intervention and require multidisciplinary approach to discuss the delicate balance of beneficence and nonmaleficence.
