Physicians' attitudes about the care of patients in the persistent vegetative state: a national survey.
OBJECTIVE
To study the attitudes and beliefs of physicians who have experience caring for patients in the persistent vegetative state (PVS).


METHODS
Mailed questionnaire survey.


METHODS
500 physicians, 250 from the American Academy of Neurology and 250 from the American Medical Directors Association.


METHODS
Physicians' beliefs about diagnosis of the PVS, patient awareness and suffering, treatment withdrawal, appropriate use of health maintenance and life-prolonging therapies, organ donation, lethal injection, and the treatment they would want if they were in the PVS.


RESULTS
68% of surveyed neurologists and 60% of medical directors responded. Thirteen percent of responders believe that patients in the PVS have awareness and experience hunger and thirst; 30% believe they experience pain. Fewer than 9% believe that respiratory failure, cardiogenic shock, acute renal failure, or cancer should be aggressively treated. Eighty-nine percent believe that it is ethical to withdraw artificial hydration and nutrition. Almost two thirds of responders believe that it would be ethical to use the vital organs of patients in the PVS for transplantation, and 20% believe that it would be ethical to hasten the patient's death by lethal injection.


CONCLUSIONS
When evaluating the appropriateness of treatments for patients in the PVS, neurologists and medical directors largely concur. Most physicians in both groups believe that patients in the PVS would be better off dead; that it is not necessary to provide aggressive therapeutic interventions; and that all therapeutic interventions, including artificial nutrition and hydration, can be withheld in certain circumstances. The areas of consensus are remarkable and suggest that an ethical standard that physicians believe should be followed when caring for these patients may be emerging.
Payne
K
K
University of Chicago, Illinois, USA.
Taylor
R M
RM
Stocking
C
C
Sachs
G A
GA
D000208:Acute Disease / Q000628:therapy; D001291:Attitude of Health Personnel; D032921:Consensus; D004750:Enteral Nutrition; D004992:Ethics, Medical; D005065:Euthanasia; D028601:Euthanasia, Active; D005260:Female; D005440:Fluid Therapy; D006707:Homes for the Aged; D006801:Humans; D008297:Male; D009462:Neurology; D009735:Nursing Homes; D018458:Persistent Vegetative State / Q000175:diagnosis / Q000628:therapy*; D008486:Physician Executives; D010820:Physicians; D040841:Resource Allocation; D012955:Societies, Medical; D013315:Stress, Psychological; D011795:Surveys and Questionnaires; D014019:Tissue Donors; D009927:Tissue and Organ Procurement; D014481:United States; D026712:Value of Life; D028761:Withholding Treatment