Brain & Life Helps Readers

AAN Offers Ethical Guidance Regarding Patients and COVID-19 Pandemic continued from cover

developed by the Ethics, Law, and Humanities Committee, a joint committee of the American Academy of Neurology, American Neurological Association, and Child Neurology Society, in collaboration with the Neurocritical Care Society Ethics Committee. The AAN position statement recommends that people with chronic neurologic disease who need to see their neurologist in non-emergency situations should be offered telehealth appointments to limit potential exposure to COVID-19. Some neurologic medications may weaken a person’s immune system, putting them at greater risk of COVID-19. For example, people taking corticosteroids or immunomodulating therapies for multiple sclerosis or myasthenia gravis may be more susceptible to COVID-19. “People should be counseled by their neurologists on how their non-emergency neurologic condition may change their risk of hospitalization and death due to a COVID-19 infection,” said position statement author Michael A. Rubin, MD, FAAN, of UT Southwestern Medical Center in Dallas and member of the AAN’s Ethics, Law, and Humanities Committee. “Entering a hospital or clinic for a non-emergency may impose a greater risk of infection than normal, even if appropriate precautions are taken.” For patients with neurologic disease severe enough to warrant hospitalization, such as those with stroke or epilepsy, the AAN states that neurologists must still endeavor to maintain the customary standard of care in this complex, new environment. “Now is one of the most challenging times of our careers as neurologists,” said AAN President James C. Stevens, MD, FAAN. “Clinics and hospitals are adapting to caring for the most ill, managing scarce resources, and trying to protect people without the disease. As neurologists, we must continue to adapt our daily practice, continue to care for our most ill neurology patients, and help contribute to the care of those afflicted with COVID-19.” The AAN also recommends that neurologists work with their patients to complete advance care planning documents.

“In the event that hospitals have to triage limited resources, it’s possible that people with advanced neurologic disease may not be offered certain elements of lifesaving care, such as ventilators and ICU beds,” said Rubin. “To ensure more control in the treatments they receive, people with advanced disease and their loved ones should discuss with their neurologist how reduced resources may impact their care and communicate their care preferences if they were to become seriously ill.”

When resources are scarce, the position statement lists criteria that should be considered when determining how those resources should be allocated, noting that decisions should be based on need, prospect of benefit, best medical evidence, and the balance of personal freedoms with the interests of the entire community, with the main goal being to maximize the number of lives saved. 

Brain & Life Helps Readers Cope with COVID-19

As people continue to reckon with the global pandemic, this month’s issue of Brain & Life ® is devoted to COVID-19, starting with the cover story on how patients’ experiences in hospitals have changed and what neurologists and other health care workers are doing to treat patients and keep them safe during this critical time.

The second feature is about anxiety— both as a symptom of many neurologic conditions and a byproduct of living through a pandemic—and how to manage it, especially during a national crisis. In the Caregiving department, caregivers of patients with dementia share the special challenges they face in trying to keep their loved ones safe and healthy and dealing with potential isolation. Telehealth is explained in the Treatment department and how patients can prepare to make each visit as productive as possible.

Brain & Life magazine is free for AAN members in the United States to distribute to patients, who also can subscribe for free. If you would like to adjust the number of copies you receive for your patients or update your clinic address, email BeGreen @ WasteFreeMail.com. All members have online access to the magazine articles and additional resources at BrainandLife.org. Please share the website with your patients! 

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COVID-19 Heroes We salute health care workers like neurologist Dr. James Conners on the front lines of care.