Family expectations may also drive

Family expectations may also drive management options especially when considering live saving but non restorative surgical intervention in a patient with a severe TBI. Although the prognosis may be judged to be very poor for a particular patient, the family may expect the neurosurgeon to perform surgery in the largely forlorn hope of a reasonable recovery in the hands of modern medicine. This may result in prolonged ICU care (if it is available) and a prolonged ward stay with death or severe disability as the outcome. The neurosurgeon has a responsibility to give the most accurate, balanced information about prognosis in this situation but also has to balance the societal cost and equitable resource allocation against family expectations. Clearly, a formidable challenge!