Abstracts

The use of pharmacologic coma (PC) to treat status epilepticus (SE) is often successful, but not always. Currently there are no established guidelines for the length of PC trial in an attempt to achieve seizure control, thus the potential arises for ethical dilemmas.
Using two case examples, we explore three concepts regarding the use of PC in the treatment of SE: 1) SE as a terminal condition; 2) PC resulting in permanent unconsciousness; and 3) using PC for extended periods to alleviate SE.
With respect to a patient[apos]s Advance Directive or Living Will, these three concepts can pose ethical complexities for the medical team. Such health care planning documents or other prior statements of treatment preferences can be relevant to PC therapy due to the notions of unconsciousness, cognitive appreciation, and life support.
Due to the risks of long term PC therapy, this intervention should be reflected upon in conjunction with the patient[apos]s best interests if the patient[apos]s preferences for treatment are not known. We argue that in the setting where PC therapy is not reversing the patient[apos]s clinical course and only offering to sustain organic life, it is ethically appropriate to discontinue such therapy and provide the patient comfort care. Similarly, if PC therapy is not [italic]expected[/italic] to improved the patient[apos]s clinical course and is only [italic]expected[/italic] to sustain organic life, then it is ethically appropriate to not offer such therapy to patients.