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End-of-life decisions in acute traumatic cervical spinal cord injury: a case series on caring through a biopsychosocial perspective and an interdisciplinary, shared decision making approach

Spinal Cord Series and Cases volume 12, Article number: 5 (2026) Cite this article

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Abstract

Introduction

Health care advancements lead to increased survival after severe cervical spinal cord injury (cSCI). Already in the acute phase, the severity of the injury with its magnitude of expected medical complications and the devastating functional prognosis, can confront the patient and its medical team with pressing medical-ethical dilemmas regarding the (dis)continuation of treatment and/or end-of-life decisions.

Case presentation

In this case series we discuss four patients with severe cSCI that were admitted to the Maastricht University Medical Center, the Netherlands, in 2024, and in whom questions regarding end-of-life decision arose within a couple of days. While the neurological presentations were very similar, the personal wishes, beliefs and psychosocial situations varied greatly. The process of shared decision making, with multiple meetings with the treatment team, the patients (when possible) and their significant others, lead to the formulation of personalized treatment plans regarding discontinuation of treatment and/or end-of-life decisions.

Discussion

This case series shows that end-of-life decisions in patients with cSCI are complex and multifactorial. A biopsychosocial approach is needed to tailor a personalized treatment plan that includes medical, prognostic, personal and external factors. An interdisciplinary team that actively involves the patient and its significant others, facilitates the process of shared decision making, which may also have a beneficial effect on the grieving process for the people left behind.

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Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study.

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Funding

No financial assistance was received in support of this study.

Author information

Author notes

  1. These authors contributed equally: Lucia J. Foxen-Snobl, Wouter A. J. Vints.

Authors and Affiliations

  1. Centre of Expertise in Rehabilitation and Audiology, Adelante Zorggroep, Hoensbroek, The Netherlands

    Lucia J. Foxen-Snobl, Wouter A. J. Vints & Charlotte C. M. van Laake-Geelen

  2. Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands

    Wouter A. J. Vints, Bas C. T. van Bussel, Toon F. M. Boselie & Charlotte C. M. van Laake-Geelen

  3. Department of Intensive Care Medicine, Maastricht University Medical Centre +, Maastricht, The Netherlands

    Bas C. T. van Bussel

  4. Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands

    Bas C. T. van Bussel

  5. Department of Neurosurgery, Maastricht University Medical Center +, Maastricht, The Netherlands

    Toon F. M. Boselie

Authors
  1. Lucia J. Foxen-Snobl
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  2. Wouter A. J. Vints
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  3. Bas C. T. van Bussel
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  4. Toon F. M. Boselie
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  5. Charlotte C. M. van Laake-Geelen
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Contributions

LF-S, WV and CvL-G contributed to conceiving and designing the work that led to the submission. LF-S and WV drafted the first version of the text. CvL-G had a role in supervision. BvB and TB revised the manuscript. All authors approved the final version of the manuscript.

Corresponding author

Correspondence to Lucia J. Foxen-Snobl.

Ethics declarations

Competing interests

The authors declare no competing interests.

Ethical approval

No ethical approval is required for the retrospective evaluation of anonymized patient data. Consent for publication of this case series could be obtained from relatives in 3 out of 4 cases. For one case, there were no known relatives or designated contact persons described in the medical record.

Consent for publication

Consent for publication of this case series could be obtained from relatives in 3 out of 4 cases. For one case, there were no known relatives or designated contact persons described in the medical record.

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Foxen-Snobl, L.J., Vints, W.A.J., van Bussel, B.C.T. et al. End-of-life decisions in acute traumatic cervical spinal cord injury: a case series on caring through a biopsychosocial perspective and an interdisciplinary, shared decision making approach. Spinal Cord Ser Cases 12, 5 (2026). https://doi.org/10.1038/s41394-026-00732-6

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