Abstract
Background: Ethical dilemmas can occur in any situation in clinical medicine. In patients undergoing neuro-anesthesia for surgical procedure evacuation of intracerebral hemorrhage with a history of hemorrhagic stroke, anticoagulants should not be given because they can cause recurrent bleeding. Meanwhile, at the same time, the patient could also be infected with coronavirus disease 2019 (COVID-19), one of treatment is the administration of anticoagulants. Methods: A case report. A 46-year-old male patient was admitted to hospital with a loss of consciousness and was diagnosed with intracerebral hemorrhage due to a hemorrhagic stroke and was confirmed positive for COVID-19. Giving anticoagulants to patients is considered counterproductive so, an ethical dilemma arises. For this reason, a joint conference was held to obtain the best ethical and medicolegal solutions for the patient. Results: By using several methods of resolving ethical dilemmas such as basic ethical principles, supporting ethical principles, and medicolegal considerations, it was decided that the patient was not to be given anticoagulants. Conclusions: Giving anticoagulants to hemorrhagic stroke patients is dangerous even though it is beneficial for COVID-19 patients, so here the principle of risk-benefit balance is applied to patients who prioritize risk prevention rather than providing benefits. This is also supported by the prima facie principle by prioritizing the principle of non-maleficence rather than beneficence, the minus malum principle by seeking the lowest risk, and the double effect principle by making the best decision even in a slightly less favorable way as well as the medicolegal aspect by assessing patient safety and risk management.
Highlights
A stroke is a brain disorder caused by blood vessel disorders that occur suddenly, this can be focal or global and can result in death within 24 hours of the onset of symptoms.[1]
Based on the location of the bleeding, hemorrhagic stroke is divided into intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH).[4]
Imaging examination in the form of a computed tomography (CT) scan is mandatory because it is an important step in the evaluation of suspected hemorrhagic stroke, as it is used to distinguish it from ischemic stroke and can identify complications.[3]
Summary
A stroke is a brain disorder caused by blood vessel disorders that occur suddenly, this can be focal or global and can result in death within 24 hours of the onset of symptoms.[1]. The patient was admitted to the ICU for 2 days, there was no improvement in the patient's level of consciousness using GCS. In this case, there was a dilemma as to whether anticoagulants could be given to hemorrhagic stroke patients with COVID-19 complications. On the first day of ICU admission, the patient still experienced a decrease in consciousness with GCS of E2M5V3, BP of 159/81 mmHg, HR of 92 beats/minute, RR of 18 times/minute, and oxygen saturation of 99% (intubated). The condition of patient on the second day was similar with GCS of E2M5V3, BP of 148/61 mmHg, HR of 135 beat per minute, RR 18 times per minute, and oxygen saturation of 98% (intubated).
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