Legal Aspects of Ethics in the Neural and Behavioral Sciences

Abstract

A major ethical issue in clinical neurology is deciding when it is proper to withhold or withdraw life-sustaining medical care from a neurologically impaired patient. The question arises most often with respect to the irreversibly comatose and children with severe mental retardation or irremediable birth defects. It may also surface in connection with various progressive or untreatable neurological diseases, some of which destroy cognitive functions (e.g., Alzheimer Disease) or which leave cognition intact but are otherwise totally incapacitating (e.g., the motor neuron diseases). Most persons subject to ethical inquiries of this sort are unable to participate in a dialogue about what is “right” for them. They lack capacity to comprehend in even the most rudimentary fashion the nature of their condition or their prospects for the future. Others must decide what level of medical care should be provided for them. As to those few who can know their prognosis and express themselves, their wishes must be heeded. A decision which excludes them would appear ethically intolerable and is legally impermissible [1,2].