Professor Henry Marsh

Brief Outline:

Henry Marsh talks about issues to be considered when thinking about neurosurgery on severely injured patients

Background:

Henry Marsh is a consultant neurosurgeon and author of 'Do No Harm: tales of life, death and brain surgery'.

Henry Marsh talks about how he asks families to consider what the patient themselves would want.

I say, “This is one of the most difficult decisions you are ever going to have to make in your life. But you know your loved one, I don’t. I’m quite certain that if we treat them they may die anyway but if they do survive they’re going to be left profoundly disabled. Now what that exactly means is often hard to predict but we’re not just talking about being partially sighted or having a weak leg. We’re talking about a profound change in their personality. They probably won’t be able to talk or think properly. They’ll be totally dependent. I can’t predict in exactly in what way. And the question you have to ask yourself is ‘Would they want to be like that? Would they want to survive in that condition? I don’t know the answer to that. You probably do because you know them. You should not be asking yourself ‘Do I love this person enough to look after them when they’re disabled?’ – of course you do, because they’re your kith and kin. But would they want to survive in a terribly damaged state?’”.  And if you put the question to the family that way you’ll get an entirely different answer from if you say, “We can operate but they’ll be left very disabled”. 

Henry Marsh explains his view that neurosurgeons need to become more aware of the negative outcomes of intervention and reflects on uncertainty.

But on the whole we do not- in Neurosurgery we do not see the long-term consequences of our decisions in terms of bad results. 

Is there a way that could be made to happen? That you think would be a good idea?

Well I think it should be part of neurosurgical trainees’ education to visit some of the long-term neurodisability units that are scattered around the place. I think one ought to go and see them, just for a visit, to get some idea of what profound brain disability is like. My trainees I think have no idea at all.

The problem from my point of view with that of course is that is that one’s never entirely certain. You always think, “Well, it’s just possible they’ll make a better recovery than I think”. So the question then becomes one of how many bad results justify one good result?

And you never know. And if you say, “I’ll only make a decision if I can be absolutely certain I’m not missing the opportunity to save one person’s good worthwhile result”, you’re running the risk you’ll condemn many patients – and above all their families - to a living hell of having a profoundly disabled relative in long-term care afterwards, which is a terrible state for families to be in.

One does need to have some feel for what happens to many people with severe brain damage and I think on the whole neurosurgeons become increasingly conservative as they get older. I think you’ll find young new consultants are much more enthusiastic about treating everybody than people my age. And it’s partly I think from experience one is more aware of the fact that many patients do very badly.