Neurocritical Care

, Volume 30, Issue 1, pp 33–41 | Cite as

Withdrawal of Life-Sustaining Treatments in Perceived Devastating Brain Injury: The Key Role of Uncertainty

  • Christos LazaridisEmail author
Ethical Matters



Withdrawal of life-sustaining treatment (WOLST) is the leading proximate cause of death in patients with perceived devastating brain injury (PDBI). There are reasons to believe that a potentially significant proportion of WOLST decisions, in this setting, are premature and guided by a number of assumptions that falsely confer a sense of certainty.


This manuscript proposes that these assumptions face serious challenges, and that we should replace unwarranted certainty with an appreciation for the great degree of multi-dimensional uncertainty involved. The article proceeds by offering a taxonomy of uncertainty in PDBI and explores the key role that uncertainty as a cognitive state, may play into how WOLST decisions are reached.


In order to properly share decision-making with families and surrogates of patients with PDBI, we will have to acknowledge, understand, and be able to communicate the great degree of uncertainty involved.


Brain injury Decision-making Disability Chronic conditions and rehabilitation End-of-life issues 



This paper was greatly improved by the careful comments, corrections, and advice given to me by L. Syd M Johnson and Sunil Kothari, to whom I am most grateful. For helpful discussion of various parts of this paper, I would like to thank audiences at the Disorders of Consciousness Program of the Texas Institute for Rehabilitation and Research (TIRR) Memorial Hermann, and at the Neuroscience in Intensive Care International Symposium (NICIS) 2018.

Author Contributions

Dr. Lazaridis conceived the article topic, wrote and revised the draft.

Compliance with Ethical Standards

Conflict of interest

The author declares that there is no conflict of interest.

Source of Support

No funding has been received in relation to this manuscript.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society 2018

Authors and Affiliations

  1. 1.Division of Neurocritical Care, Departments of Neurology, and NeurosurgeryUniversity of ChicagoChicagoUSA
  2. 2.The University of Chicago MedicineChicagoUSA

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