Ethical Analysis of the Decision-making Process for Patients with Acute Severe Stroke*

This article discusses the case of an elderly patient with a severe stroke for whom hemicraniectomy was proposed to lower intracranial pressure. Although patients in this situation can increase their chances of survival with hemicraniectomy, expected quality of life following the procedure remains uncertain. This case is analyzed using the four topics chart, which consists of medical indication, patient preference, quality of life, and contextual features. In relation to contextual features, the conflict of interest experienced by the family as caregivers and the influence of the Life-Sustaining Treatment Decision-making Act are discussed. It is argued that in order to make medical decisions that are in the patient’s best interest, shared decision-making between physicians and family members should be based on information obtained through the four topics chart.