Evidence map›Paper›PMID 32124448›Full record

ArticleBioethics2020

Burying our mistakes: Dealing with prognostic uncertainty after severe brain injury.

Mackenzie Graham

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Bioethics, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
12citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

12 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
  3. Article
  4. Review
  5. Article
  6. Review
  7. Article
  8. Review
  9. Review
  10. Well-Being After Severe Brain Injury: What Counts as Good Recovery?Cambridge quarterly of healthcare ethics : CQ : the international journal of healthcare ethics committees · 2021
    Article
  11. Article
  12. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

1 author.

Mackenzie GrahamUehiro Centre for Practical Ethics, Oxford University, UK and Wellcome Centre for Ethics and Humanities, Oxford University, UK.ORCID 0000-0001-6870-1370

Funding

Wellcome TrustWellcome Trust 203132/Z/16/Z
6 · The paper itself

Abstract

Prognosis after severe brain injury is highly uncertain, and decisions to withhold or withdraw life-sustaining treatment are often made prematurely. These decisions are often driven by a desire to avoid a situation where the patient becomes 'trapped' in a condition they would find unacceptable. However, this means that a proportion of patients who would have gone on to make a good recovery, are allowed to die. I propose a shift in practice towards the routine provision of aggressive care, even in cases where the probability of survival and acceptable recovery is thought to be low. In conjunction with this shift, I argue in favour of a presumption towards withdrawing life-sustaining treatment, including artificial nutrition and hydration, when it becomes clear that a patient will not recover to a level that would be acceptable to them. I then respond to three potential objections to this proposal.

Indexed as

Decision MakingBrain InjuriesHumansLife Support CarePrognosisUncertaintyWithholding Treatmentbrain injurydecision-makingend-of-life treatmentneuroethicsprognostic uncertainty

Identifiers

PMID32124448
PMCPMC7318633

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.