Should treatment keeping alive patients in a vegetative state or in a minimally conscious state be stopped? Would doctors and nurses accept to survive in the stranglehold of such states? Is a vegetative state worse than death? The Journal of Neurology has recently published the results of a vast enquiry carried out by the University of Liège’s Coma Science Group.

Between September 2007 and October 2009, Professor Steven Laureys, the Director of the Coma Science Group at the University of Liège’s Cyclotron Research Centre (CRC), took part in 59 medical and scientific conferences and congresses in Europe. At the end of each of these events he systematically handed to the participants a document consisting of 16 questions centred on ethical considerations related to the vegetative state (VS), the minimally conscious state (MCS) and locked-in syndrome (LIS). Beforehand the people questioned had received detailed information concerning these particular states of consciousness. They were then asked to respond either ‘yes’ or ‘no’ to the questions they were set. To enable a more nuanced interpretation of the results five demographic pieces of information were collected from each participant: age, gender, nationality (32 countries divided into 3 geographical zones – Northern, Central and Southern Europe), profession and religious beliefs – more specifically whether or not they believed in God and subscribed to an institutional religion (Christianity, Islam, Judaism, etc.), without necessarily being practicing.

It was within this framework that Athena Demertzi, a Greek neuro-psychologist currently working on her doctoral thesis at the Coma Science Group,  analysed the responses provided by 2,475 doctors and members of the paramedical sector (1) (essentially nurses) to 6 out of the 16 questions posed. This work has recently been the subject of a publication in the Journal of Neurology(2).   

Stopping treatment

Let’s get to the heart of the matter. Some 66% of the people asked (3) judge it acceptable to stop treatment (artificial nutrition and hydration) for patients plunged into a chronic vegetative state (over a year), whilst only 28% of the respondents (27% of the doctors, 23% of the paramedical personnel) estimate that this measure is justified when addressed to patients in a minimally conscious state who had fluctuating residual consciousness combined with an inability to communicate their thoughts.

When the criteria of minimally conscious states were defined in 2002 by Joseph Giacino, of New Jersey Neuroscience Institute, a number of neurologists doubted the pertinence of introducing into the nomenclature a new clinical entity which, in their eyes, was merely a sub-category of the vegetative state. ‘They couldn’t see the value of creating a specific entity for patients who remained very handicapped, to the point of not being able to communicate,’ explains Steven Laureys.

(1) The sample was made up of around two thirds doctors and one third members of paramedical personnel..
(2) A. Demertzi, D. Ledoux, M.-A. Bruno, A. Vanhaudenhuyse, O. Gosseries, A. Soddu, C. Schnakers, G. Moonen, S. Laureys, Attitudes towards end-of—life issues in disorders of consciousness : a European survey, J. Neurol, in press.
(3) On this point the percentages are identical for the two major components of the sample, - doctors and paramedics..