Ethical value of cranioplasty with oppressive binder as a way of limiting life support treatments


  • Alfonso Canabal Berlanga Asociación de Bioética de Castilla la Mancha
  • José Jara Rascón Asociación de Bioética de la Comunidad de Madrid
  • Rafael Gómez Rodríguez Asociación de Bioética de Castilla la Mancha
  • Ricardo Abengózar Muela Universidad Francisco de Vitoria de Madrid
  • Francisco Javier Ruiz Hornillos Comité de Ética Asistencial de la Fundación Jiménez Díaz
  • José Manuel Moreno Villares Comité de Ética Asistencial del Hospital 12 de Octubre
  • Manuel de Santiago Corchado Universidad Rey Juan Carlos
  • L. Fernando Viejo Llorente Comisión de Ética y Deontología del Colegio Médicos de Toledo
  • José Carlos Abellán Salort Universidad Rey Juan Carlos
  • Álvaro Gándara del Castillo Sociedad Española de Cuidados Paliativos (SECPAL)


This article analyzes, from a critical perspective, the use of cranioplasty with oppressive binder as a method to limit life support treatment (LLST). Some authors have proposed that this active technique provokes encephalic death, allowing organ donation. Contrasting this procedure with the recommendations of the consent document about treatment of critical patients at the end of life, elaborated by the bioethics group of SEMICYUC, it is shown that the means and ends of this technique do not match with the proper actions of LLST, based on the withdrawal of life support means or in not starting them, considering such means disproportionate or extraordinary in some cases, thus avoiding the therapeutic obstinacy. The definition of LLST allows to clarify the limits in which, in a way ethically fair and with a consensus, the acts at the end of life are included in the medical goals, avoiding the suspicion that these acts may be misinterpreted as justifying an abusive extraction of organs. This article concludes that the direct provocation of encephalic death by the technique of cranioplasty with binder does not appear to fulfill the criteria proper of LLST.


cranioplasty, limitation of life support treatment, organ donation, decompressive craniotomy