title: Primo non nocere or maximum survival in grade 2 gliomas? A medical ethical question.
abstract: BACKGROUND
  Maximum safe resection is the "gold standard" in surgical treatment of grade 2 gliomas (G2Gs), aiming to achieve maximal survival benefit with minimal risk of functional deficit.
  
  
  OBJECTIVE
  To investigate the attitude of patients and experts towards more extensive surgery with a trade-off between neurological function and survival time.
  
  
  METHODS
  Eight patients and seven experts participated in semi-structured focus group interviews.
  
  
  RESULTS
  Both patients and experts accepted the premise of balancing neurological function versus longevity. Some patients would accept an increased risk of permanent neurological deficits in order to obtain a chance of increased survival. There was a significant variance in what constituted "quality of life" both between patients and for the individual patient over time.
  
  
  CONCLUSIONS
  In important life-changing decisions there is no "one size fits all". We find that it is ethically acceptable to offer more extensive surgery than is possible within the concept of maximal safe surgery as a treatment option, when balancing the principles of beneficence, non-maleficience, autonomy and justice supports the decision. At the same time it must be remembered that even when the patients have made a well-informed decision, some will regret it. In that situation it will be our job as healthcare professionals to support them and help carry some of this burden.
authors.affiliation: Copenhagen Neurosurgery, Neuroscience Centre, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 København Ø, Copenhagen, Denmark, Jannick.brennum@regionh.dk.
authors.forename: Jannick
authors.initials: J
authors.lastname: Brennum
authors.forename: Carolina Magdalene
authors.initials: CM
authors.lastname: Maier
authors.forename: Kerstin
authors.initials: K
authors.lastname: Almdal
authors.forename: Christina Malling
authors.initials: CM
authors.lastname: Engelmann
authors.forename: Mickey
authors.initials: M
authors.lastname: Gjerris
mesh_terms: D000328:Adult; D004992:Ethics, Medical; D005260:Female; D005910:Glioma / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D019635:Neurosurgical Procedures / Q000941:ethics*; D011183:Postoperative Complications; D011788:Quality of Life / Q000523:psychology*; D015996:Survival Rate