Abstract
When more than one course of action is medically appropriate, how do surgeons decide on the best treatment for their patients? Surgeons are subject to many forms of influence and bias which can inform their decision-making processes. These decisions can be ethically charged because there are so many nonscientific factors affecting the decisions, so feelings may often be trumping evidence, which may be an uncomfortable but necessary position for many neurosurgeons.
Important ambiguities in care exist in most subspecialty areas of neurosurgery, and in this chapter there are disease-based examples from spine surgery, neuro-oncology, and neurovascular surgery and treatment modality-specific examples including radiosurgery and endoscopic surgery. Some of the factors influencing decision-making include surgeon bias, surgeon comfort level, training, availability of good evidence and the process of trying to obtain it, and conflicts of interest. Strategies to try to improve decision-making are presented including teamwork, embracing the input of the patient and his/her family, and living within financial/resource constraints.
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Bernstein, M., Jain, V.K. (2014). Ethical Decision-Making. In: Ammar, A., Bernstein, M. (eds) Neurosurgical Ethics in Practice: Value-based Medicine. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-54980-9_12
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DOI: https://doi.org/10.1007/978-3-642-54980-9_12
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