Paper on Navigating Neuropsychology: Ethics, Legal Challenges, and Clinical Insights in Traumatic Brain Injuries

Introduction

Over the past decade, the growth of neuropsychology as a clinical specialty has been well documented. Typically, because of the framework provided by ethics, we get to understand and examine morality, which widely delineates the socially accepted standards about appropriate and inappropriate human behavior and covers consensual rights, virtues, and governing rules. According to Grishina et al., 2019, more neuropsychologists have become integral donors in the forensic domain, specifically in the legal actions on cases involving patients suffering from brain injuries. The medical profession is becoming more and more independent of technological innovations and market forces that tend to influence decision-making by doctors. Significant challenges of autonomy, confidentiality, and legal and ethical issues are the main factors that provide guidelines when doctors are making decisions.

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Fundamentally, ethical concerns become more complex in cases of brain injuries, organ transplants, and clinical trials, among others. Nevertheless, the principles of ethics remain the same in all circumstances since they are focused at nourishing ethical standards among registered medical clinicians. Furthermore, patient results after a critical brain injury are highly variable since some of the patients might recover while others may end up having unresponsive wakefulness syndrome. Grishina et al., 2019 maintain that, in both instances, assessment is challenging, and misdiagnosis may be as high as 44%. Ethical principles and legal issues apply in cases where the patient might find it hard to interpret the negative outcomes, restriction of communication to a yes or no question, and sometimes the cost of the medical service. Brain injury patients who end up in a vegetative state can experience cases of traumatic and non-traumatic brain injury. For instance, Donna suffered a traumatic brain injury where she could not remember some of her past friends as a result of being hit by a drunk driver.

The ethical principle also relates to brain injury in that the evaluation of competency in a patient with damage has become a prime concern to clinicians dealing with these cases. Ethical principles require all clinicians to be well-trained and familiar with the different definitions and frameworks of competency. In addition, moral principles need clinicians to have the skill to agree to treatment, care for self-property, and direct financial dealings with appropriate care. Doctors are advised to increase a patient's individualism and prevent a paternalistic incident. Moreover, the treatment of the patient should be managed towards the advancement of compensatory behaviors in order to permit secure and triumphant societal rehabilitation with as much nobility and individualism as possible.

Conversely, healthcare workers have a legal duty of privacy and confidentiality that urges them to protect their patients against misappropriate disclosure of patient health information. Privacy and confidentiality in a health care setting entail that the practitioner should keep absolute confidence with the patients. This means that the clinicians involved in neuropsychology should not tell anyone other than those who need to know the information. Confidentiality is essential since it allows patients to come forward with their issues.

Clinical Signs and Symptoms of Traumatic Brain Injury

Traumatic brain injury normally results from an aggressive hit to the head or the body of an individual. Technically, any object that penetrates the brain tissue of a human being such as a bullet can result in serious traumatic brain injury. As a result, a brain injury may develop and cause harm to the brain cells temporarily. In other cases, more severe traumatic brain injury can lead to swelling, torn tissues, hemorrhage, and other physical damage to the brain of a human being. The lesions can result in long-term problems or even death at some point. Traumatic brain injury has an extensive range of physical and emotional effects on the human brain. Typically, some signs may take shape suddenly after the traumatic incident, while others appear after some time or months.

The loss of consciousness may be accompanied by mild traumatic brain injury for perhaps a few seconds to a few minutes. An individual with mild traumatic injury may experience amnesia that may last for about 24 hours, depending on the time of injury. In most cases, loss of consciousness is accompanied by a loss of vision and balance. However, in the case of a moderate and serious traumatic brain injury, the loss of consciousness can last for even hours, depending on the impact of the blow and the health state of the person. The patient might also experience persistent headaches that may worsen after some time. Most brain injury problems may end over the course of the year, but patients with severe brain injury, and headaches can last up to more than a year. According to (Jang & Lee, 2017), approximately 21% of patients have experienced worsening headache symptoms over a year period.

Severe traumatic brain injury may also be accompanied by sensory symptoms, for example, ringing in the ears, blurred eye vision, and a sometimes-awful taste in the mouth. Moreover, an individual with brain injury may be sensitive to light or even sound. Some patients may experience instances of vomiting fatigue and difficulties when sleeping. Approximately 45% of people with mild and severe traumatic disorders have issues related to insomnia (Grishina et al., 2019). However, the incidence of patients with insomnia is hard to detect since people with brain injuries may also suffer from fatigue disorder. Brain injury resulting from a concussion may temporarily affect the brain thereby causing confusion and problems with speech, vision, and balance. The patient may appear fine at first but symptoms may appear after some hours.

Severe traumatic brain injury can also cause a patient to experience loss of coordination. These may be followed by an individual undergoing weaknesses and reduced reflexes and sensations, thereby affecting one's coordination. Nonetheless, in a case where discoordination occurs, it can mostly affect the left side and the right side. Although, in some rare instances, it may happen to both sides of the body, thereby causing discomfort and pain to the individual. Clear fluid from the ears and nose may start leaking from the ears and nose of patients who have a severe traumatic brain injury. In addition, black eyes and bruised skin at the back of the ears indicate that the hit was enough to fissure the blood vessels around the eyes and ears. Sleepiness is also a common problem affecting patients suffering from traumatic brain injury. Although most patients in medical care benefit from sleepiness, a small percentage of these traumatic brain injury patients remain sleepy even after the injury.

Another symptom caused by traumatic brain injury is the dilation of both pupils, mostly because of a condition known as uncle herniation that causes mechanism compression of the cranial nerve and the brain stem compromise. As a result, an individual may experience weakness and a feeling of numbness in fingers and toes because of irritation and compression. Finally, an individual with traumatic brain injury may undergo depression and sometimes feeling anxious from time to time. Some patients may start feeling mood changes or mood swings because of the damage in the brain. With a traumatic brain injury, an individual may feel the need to express emotions. According to (Malina et al., 2005), patients with brain injury are more likely to experience depression than those who do not have the disease. The risk of depression after a traumatic brain injury increases whether the damage is mild, moderate, or severe. Children and infants who have traumatic brain injuries might not be able to communicate because of severe pains in the head, and some may be prone to persistent crying and seizures.

References

Grishina, E., Shiryaeva, S., Sheiafetdinova, N., & Solovyev, A. (2019). Forensic Medical Examination of the Quality of Medical Care: Legal, Methodological, and Ethical Issues. International Journal Of Psychosocial Rehabilitation, 23(4), 668-679. https://doi.org/10.37200/ijpr/v23i4/pr190400

Jang, S., & Lee, H. (2017). Traumatic axonal injury despite clinical phenotype of mild traumatic brain injury: a case report. Brain Injury, 31(11), 1534-1537. https://doi.org/10.1080/02699052.2017.1376754

Malina, A., Nelson, N., & Sweet, J. (2005). Framing the Relationships in Forensic Neuropsychology. Journal Of Forensic Neuropsychology, 4(3), 21-44. https://doi.org/10.1300/j151v04n03_03