Ethical dilemmas in neurotraumatology

The so-called "principles of medical ethics" (patient's autonomy, beneficence, non-maleficence and justice) may not be applied to many cases of severe head injury. How to respect the autonomy of a comatose or psychotic patient? What is beneficence for a patient in a posttraumatic vegetative state? Is large decompressive craniectomy ethically (and economically) justified? Is death better than a "life not worth living"? Who is going to answer these questions? A doctor, a patient's relative, or a hospital administration? In urgent cases were are confronted with: 1) shortage of time in severe TBI; 2) unconscious state of patients; 3) the need for urgent sorting and transportation in natural and man-made disasters; 4) lack of diagnostic and clinical resources. Ethical dilemmas in neurotraumatology need to be widely discussed in search of their solution.