Calvin W. Howard BSc (Hon,), MD
Neurosurgical patients face dire outcomes infringing upon their functional capacity. Often, the impairment of a
neurosurgical patient may be so severe patients will indefinitely require assistance with the majority of activities
of daily living. These patients may be left unable to communicate, be left largely unable to interact with their
environment, and may very well be unable to comprehend the world around them to their previous extent. Over
decades of exposure to such tragic outcomes, it is not uncommon for neurosurgeons to ponder if these patients
would have been better off dead. Within the common situation of a severe acute subdural hematoma, there is often
controversy amongst the surgical team as to whether an operation should occur as the patient is often left severely
impaired at best. To further explore the ethics of when to operate, the case of a severe acute subdural hematoma
is used to guide discussion and ultimately suggest approaches in practice.
