Events and decision-making in the long-term care of Dutch nursing home patients in a vegetative state.
OBJECTIVE
To clarify characteristics of long-term care and treatment of patients in a vegetative state.


METHODS
Qualitative, descriptive study in a Dutch nursing home.


METHODS
Review of clinical records of patients in a vegetative state after acute brain damage between 1978-2002.


RESULTS
Five patients received intensive care of a multi-disciplinary team and showed considerable co-morbidity. There was no standard scenario for end-of-life decisions. Physicians play a more proactive role by evaluating the total medical treatment instead of withholding therapy in case of incidental complications. The families' attitude is a crucial factor in their ultimate decision.


CONCLUSIONS
There is no standard solution to alleviate the fate of patients in a vegetative state and their families. Withdrawing all medical treatment, including artificial nutrition and hydration, can be an acceptable scenario for letting the patient die. More research is needed to identify the factors that contribute to acceptance of the physician's decision by the family.
Lavrijsen
Jan
J
'De Zorgboog' Nursing Homes, Bakel, The Netherlands. j.lavrijsen@vphg.umcn.nl
van den Bosch
Hans
H
Koopmans
Raymond
R
van Weel
Chris
C
Froeling
Paul
P
D000293:Adolescent; D000328:Adult; D001930:Brain Injuries / Q000150:complications / Q000523:psychology; D003657:Decision Making; D005066:Euthanasia, Passive / Q000523:psychology; D005260:Female; D006801:Humans; D008134:Long-Term Care / Q000379:methods*; D008297:Male; D009426:Netherlands; D009735:Nursing Homes; D018458:Persistent Vegetative State / Q000209:etiology / Q000451:nursing* / Q000523:psychology; D011368:Professional-Family Relations; D012189:Retrospective Studies