Guidelines for end-of-life care in stroke

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  • 脳卒中における終末期医療に関するガイドライン

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Abstract

<p>When a patient’s condition becomes irreversible due to a severe stroke, the decision regarding continuing treatment and care is left to the staff at the clinical site, except in the case of legal brain death determination assuming organ donation. Because of its sudden onset, stroke has a special property that the patient’s premorbid wishes cannot be confirmed in most cases. The Japan Stroke Society has established these guidelines for the purpose of supporting decision-making for treatment and care by the medical team at the clinical site. In these guidelines, “whole brain dysfunction in stroke” is defined as irreversible dysfunction of the whole brain due to stroke, and the patient is in a state in which death is inevitable regardless of any treatment. We also recommend that, if organ donation is not carried out, the final determination of whole brain dysfunction should be made in the way prescribed in these guidelines when a stroke patient is regarded as at a terminal stage and the patient’s family wishes cessation or a change in life-sustaining treatment. When whole brain dysfunction is then finally confirmed, the medical team at the site may stop or withdraw the life-sustaining treatment with the approval of the hospital director after deliberation by the clinical ethics committee of the institution.</p>

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