What does this research mean for the field?

End-of-life decisions regarding terminal extubation in patients with severe spinal cord injuries require an interdisciplinary, patient-centered approach to accurately assess decision-making capacity and respect patient autonomy while mitigating potential ableist bias. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To examine ethical challenges, capacity assessments, and autonomy considerations regarding terminal extubation in patients with traumatic high-level cervical spinal cord injury.

September 5, 2026Journal of Palliative Care

Respecting Spinal Cord Injury Patient Autonomy in the Context of Terminal Extubation

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Authors

RWRainy B.S. WortelboerBrown University LHLauren HallBrown University FKFareea KhaliqVA Boston Healthcare System

Discussion

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Implication

Case report and ethical analysis demonstrates the process of honoring terminal extubation requests in cervical spinal cord injury, highlighting patient autonomy and decision-making capacity.

Key Points

To examine ethical challenges, capacity assessments, and autonomy considerations regarding terminal extubation in patients with traumatic high-level cervical spinal cord injury.
Conducted a case-based ethical analysis of an 88-year-old male with traumatic cervical spinal cord injury dependent on mechanical ventilation via tracheostomy.
Performed serial psychiatric evaluations and multidisciplinary assessments across multiple care settings to distinguish adjustment disorder from consistent, competent care preferences.
The patient maintained a consistent, long-term preference across weeks and months to avoid permanent ventilator dependence despite initial concerns regarding depression.
Interdisciplinary teams confirmed decision-making capacity, facilitating hospice election and palliative extubation with family support, followed by death 48 hours later.

Cite This Study

Wortelboer et al. (2026) studied this question.

synapsesocial.com/papers/6a9bd3c76b95aff0620eafa0 https://doi.org/10.1177/08258597261472558

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Implication

Case report and ethical analysis demonstrates the process of honoring terminal extubation requests in cervical spinal cord injury, highlighting patient autonomy and decision-making capacity.

Respecting Spinal Cord Injury Patient Autonomy in the Context of Terminal Extubation

Discussion

Member takes

Implication

Key Points

Cite This Study

Respecting Spinal Cord Injury Patient Autonomy in the Context of Terminal Extubation

Discussion

Member takes

Implication

Key Points

Cite This Study

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