Critical Care Problem in a Case of Intracerebral Hemorrhage Due to Eclampsia and Its Ethics and Medicolegal Consideration

Authors

  • Kulsum Kulsum Department of Anesthesiology and Intensive Therapy, Medical Faculty, Universitas Syiah Kuala, The Zainoel Abidin Hospital, Banda Aceh, Indonesia; Neuro-anesthesia and Critical Care Consultant, Medical Faculty, Universitas Syiah Kuala, The Zainoel Abidin Hospital, Banda Aceh, Indonesia
  • Taufik Suryadi Department of Forensic Medicine and Medicolegal, Medical Faculty, Universitas Syiah Kuala, The Zainoel Abidin Hospital, Banda Aceh, Indonesia; Ethics and Medicolegal Consultant, Medical Faculty, Universitas Syiah Kuala, The Zainoel Abidin Hospital, Banda Aceh, Indonesia

DOI:

https://doi.org/10.3889/oamjms.2022.8341

Keywords:

Critical care, Eclampsia, Ethics-medicolegal, Intracerebral hemorrhage

Abstract

BACKGROUND: Eclampsia accompanied by hemolysis elevated liver enzymes low platelet (HELLP) syndrome is an emergency condition during late trimester pregnancy characterized by hypertension, seizures, and coma. Obstetric history is known that the patient does not conducted antenatal care regularly to the doctor so that the patient does not know she has eclampsia. One of which complications due to eclampsia is intracerebral hemorrhage which is a major cause of death and morbidity in pregnant woman. This case report discusses how ethical and medicolegal decision-making for procedures to withholding or withdrawing life support for the critical care problem. The ethical dilemma faced by neuroanesthesia and critical care (NACC) consultants is whether to continue to treat patients in the intensive care unit (ICU) even though the results will be in vain or to restrict critical care because they concluded that the condition of the patient has a terminal stage.

CASE REPORT: A reported case of a 23-year-old woman, pregnant, and had a caesarian section for the indication of eclampsia accompanied by HELLP syndrome in rural hospital. Because the patient’s condition worsened, she was referred to Zainoel Abidin hospital due to decrease in consciousness and a computed tomography scan of the head showed extensive bleeding. The results of the neuroanesthesia and neurosurgery team’s assessment stated that there was no indication of surgery on the patient because extensive bleeding had occurred accompanied by brain edema. The patient then undergoes treatment in the ICU to improve the patient’s critical condition. In an effort to overcome this problem, the NACC consultant consults with an ethics and medicolegal consultant as a representation of the medical committee and ethical committee to determine the withholding or withdrawing of life support therapy to the patient.

CONCLUSION: Life support therapies that can be withhold or withdraw are simply an extraordinary treatment that provides no benefit. The basic principles of ethics in making decisions to do withholding and withdrawing life support in these patients are beneficence and non-maleficence, while the medicolegal principle in these patients lies in the patient’s condition being medically incurable (terminal state) and medical treatment is useless (futile treatment).

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References

Triana E, Syahredi SA. Antepartum eclampsia in G5P4A0H3 gravid preterm 33-34 weeks + HELLP syndrome + Acute kidney injury+ IUFD. J Kes Andalas. 2019;8:79-83. DOI: https://doi.org/10.25077/jka.v8i1S.930

Lusiana N. Factors related to the incidence of preeclampsia in pregnant women in the Camar room II Arifin Achmad Hospital, Riau Province in 2014. J Kes Kom. 2015;3(1):29-33. DOI: https://doi.org/10.25311/keskom.Vol3.Iss1.98

Ahishali E. Liver diseases associated with pregnancy. Marmara Med J. 2012;25:1-4.

Cippola MJ, Kraig RP. Seizures in women with preeclampsia: Mechanisms and management. Fetal Matern Med Rev. 2011;22(2):91-108. https://doi.org/10.1017/S0965539511000040 PMid:21709815 DOI: https://doi.org/10.1017/S0965539511000040

Minire A, Mirton M, Imri V, Lauren M, Aferdita M. Maternal complications of preeclampsia. Med Arch. 2013;67(5):339-41. DOI: https://doi.org/10.5455/medarh.2013.67.339-341

Septica RI, Uyun Y, Suryono B. Cerebrovascular pathophysiology and anesthesia implications in preeclampsia/eclampsia. J Neuroanes Indon. 2015;4(2):134-48.

Regnier J, Pierssens AR, Boulain T, Carpentier F, Le Borgne P, Delnista D, et al. Withholding and withdrawing life-support in adults in emergency care: Joint position paper from the French intensive care society and French society of emergency medicine. Ann Intensive Care. 2019;9(105):1-7. https://doi.org/10.1186/s13613-019-0579-7 PMid:31549266 DOI: https://doi.org/10.1186/s13613-019-0579-7

Salloch S. Same same but different: Why we should care about the distinction between professionalism and ethics. BMC Med Eth. 2016;17(44):1-6. DOI: https://doi.org/10.1186/s12910-016-0128-y

Muhani B, Besral B. Severe pre-eclampsia and maternal death. J Kes Mas Nas. 2015;10(2):80-6. DOI: https://doi.org/10.21109/kesmas.v10i2.884

Hammer ES, Cippola MJ. Cerebrovascular dysfunction in preeclamptic pregnancies. Curr Hypertens Rep. 2015;17(8):1-13. https://doi.org/10.1007/s11906-015-0575-8 PMid:26126779 DOI: https://doi.org/10.1007/s11906-015-0575-8

Varkey B. Principles of clinical ethics and their application to practice. Med Princ Pract 2021;30(1):17–28. https://doi.org/10.1159/000509119 PMid:32498071 DOI: https://doi.org/10.1159/000509119

Welle JV, ten Have HA. The ethics of forgoing life-sustaining treatment: Theoretical considerations and clinical decision making. Multidiscip Resp Med. 2014;9(14):1-8. https://doi.org/10.1186/2049-6958-9-14 PMid:24618004 DOI: https://doi.org/10.1186/2049-6958-9-14

Phua J, Joynt GM, Nishimura M, Deng Y, Myatra SN, Chan YH, et al. Withholding and withdrawal of life-sustaining treatments in intensive care units in Asia. JAMA Intern Med. 2015;175(3):363-71. https://doi.org/10.1001/jamainternmed.2014.7386 PMid:25581712 DOI: https://doi.org/10.1001/jamainternmed.2014.7386

Willmott L, White B, Smith MK, Wilkinson DJ. Withholding and withdrawing life-sustaining treatment in a patient’s best interests: Australian judicial deliberations. Med J Aust. 2014;201(9):545-7. https://doi.org/10.5694/mja13.10874 PMid:25358584 DOI: https://doi.org/10.5694/mja13.10874

Malik MM. Islamic perceptions of medication with special reference to ordinary and extraordinary means of medical treatment. Bangladesh J Bioethics. 2013;4(2):22-33. DOI: https://doi.org/10.3329/bioethics.v4i2.16373

Suryadi T. Bioethical and medicolegal aspects withholding and withdrawing life support therapy in critical care. J Ked Syiah Kuala. 2017;17(1):60-4. DOI: https://doi.org/10.24815/jks.v17i2.8990

McTavish RJ. Justice and health care: When “ordinary” is extraordinary. Linacre Q. 2016;83(1):26-34. https://doi.org/10.1080/00243639.2015.1123891 PMid:27833180 DOI: https://doi.org/10.1080/00243639.2015.1123891

Kearns AJ, Gordijn B. Withholding and withdrawing life-saving treatment: Ordinary/extraordinary means, autonomy and futility. Anal I Egzystencja. 2018;42:5-33. DOI: https://doi.org/10.18276/aie.2018.42-01

Republic of Indonesia. Regulation of the Minister of Health of the Republic of Indonesia Number 37 of 2014, Concerning the Withholding and Withdrawing Life Support Therapy. Indonesia: Republic of Indonesia; 2014.

Republic of Indonesia. Regulation of the Minister of Health of the Republic of Indonesia Number 290 of 2008, Concerning Approval and Rejection of Medical Treatment. Indonesia: Republic of Indonesia; 2008.Open Access Maced J Med Sci. 2022 Jan 26; 10(C):67-71. 71

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Published

2022-01-26

How to Cite

1.
Kulsum K, Suryadi T. Critical Care Problem in a Case of Intracerebral Hemorrhage Due to Eclampsia and Its Ethics and Medicolegal Consideration. Open Access Maced J Med Sci [Internet]. 2022 Jan. 26 [cited 2024 Mar. 28];10(C):67-71. Available from: https://oamjms.eu/index.php/mjms/article/view/8341

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Case Reports in Gynecology and Obstetrics

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