End-of-life decisions in acute traumatic cervical spinal cord injury: a case series on caring through a biopsychosocial perspective and an interdisciplinary, shared decision making approach

IntroductionHealth care advancements lead to increased survival after severe cervical spinal cord injury (cSCI). Already in the acute phase, the severity of the injury with its magnitude of expected medical complications and the devastating functional prognosis, can confront the patient and its medical team with pressing medical-ethical dilemmas regarding the (dis)continuation of treatment and/or end-of-life decisions.Case presentationIn this case series we discuss four patients with severe cSCI that were admitted to the Maastricht University Medical Center, the Netherlands, in 2024, and in whom questions regarding end-of-life decision arose within a couple of days. While the neurological presentations were very similar, the personal wishes, beliefs and psychosocial situations varied greatly. The process of shared decision making, with multiple meetings with the treatment team, the patients (when possible) and their significant others, lead to the formulation of personalized treatment plans regarding discontinuation of treatment and/or end-of-life decisions.DiscussionThis case series shows that end-of-life decisions in patients with cSCI are complex and multifactorial. A biopsychosocial approach is needed to tailor a personalized treatment plan that includes medical, prognostic, personal and external factors. An interdisciplinary team that actively involves the patient and its significant others, facilitates the process of shared decision making, which may also have a beneficial effect on the grieving process for the people left behind.