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Ethical and Legal Considerations in the Management of an Unbefriended Patient in a Vegetative State

Overview of attention for article published in Neurocritical Care, May 2017
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About this Attention Score

  • In the top 25% of all research outputs scored by Altmetric
  • High Attention Score compared to outputs of the same age (80th percentile)
  • High Attention Score compared to outputs of the same age and source (86th percentile)

Mentioned by

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15 tweeters

Citations

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3 Dimensions

Readers on

mendeley
22 Mendeley
Title
Ethical and Legal Considerations in the Management of an Unbefriended Patient in a Vegetative State
Published in
Neurocritical Care, May 2017
DOI 10.1007/s12028-017-0405-8
Pubmed ID
Authors

Alexandra Lloyd-Smith Sequeira, Ariane Lewis

Abstract

Patients without surrogates are referred to as "unbefriended." Because these patients do not have representatives to assist with medical decision-making, patient autonomy and self-determination, fundamental concepts of American healthcare, are jeopardized. We present a case of an unbefriended patient in a vegetative state and discuss the ethical and legal complications associated with management of unbefriended patients. An unbefriended patient was admitted to our hospital with a cardiac arrest in the setting of an intracerebral hemorrhage. Despite aggressive medical and surgical management, he suffered significant brain injury and was in a vegetative state. In our state, unless an unbefriended patient will imminently die despite medical therapy, all measures must be taken to prolong the patient's life, so a tracheostomy and feeding tube were placed and he was transferred to a long-term care facility. The process for making decisions on behalf of unbefriended patients is complicated and varies throughout the country. Some potential ways to avoid these complex situations include: early conversations about treatment wishes while patients have capacity, mandatory advance directives, and increased training and reimbursement for physicians to proactively have end-of-life discussions. The unbefriended are one of the most high-risk patient groups. Because our patient had no surrogate with whom we could have a goals-of-care discussion, we were obligated to continue aggressive management despite knowing it would prolong, but not improve, his life. Proactive preventative measures to identify and document end-of-life wishes may make management of these patients less ethically and legally complicated.

Twitter Demographics

The data shown below were collected from the profiles of 15 tweeters who shared this research output. Click here to find out more about how the information was compiled.

Mendeley readers

The data shown below were compiled from readership statistics for 22 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Unknown 22 100%

Demographic breakdown

Readers by professional status Count As %
Student > Master 5 23%
Unspecified 4 18%
Professor > Associate Professor 4 18%
Researcher 4 18%
Student > Bachelor 3 14%
Other 2 9%
Readers by discipline Count As %
Medicine and Dentistry 7 32%
Unspecified 5 23%
Nursing and Health Professions 4 18%
Psychology 2 9%
Philosophy 1 5%
Other 3 14%

Attention Score in Context

This research output has an Altmetric Attention Score of 9. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 23 August 2018.
All research outputs
#1,882,755
of 13,411,840 outputs
Outputs from Neurocritical Care
#93
of 739 outputs
Outputs of similar age
#52,707
of 264,182 outputs
Outputs of similar age from Neurocritical Care
#5
of 37 outputs
Altmetric has tracked 13,411,840 research outputs across all sources so far. Compared to these this one has done well and is in the 85th percentile: it's in the top 25% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 739 research outputs from this source. They receive a mean Attention Score of 4.5. This one has done well, scoring higher than 87% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 264,182 tracked outputs that were published within six weeks on either side of this one in any source. This one has done well, scoring higher than 80% of its contemporaries.
We're also able to compare this research output to 37 others from the same source and published within six weeks on either side of this one. This one has done well, scoring higher than 86% of its contemporaries.