title: Events and decision-making in the long-term care of Dutch nursing home patients in a vegetative state.
abstract: 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.
authors.affiliation: 'De Zorgboog' Nursing Homes, Bakel, The Netherlands. j.lavrijsen@vphg.umcn.nl
authors.forename: Jan
authors.initials: J
authors.lastname: Lavrijsen
authors.forename: Hans
authors.initials: H
authors.lastname: van den Bosch
authors.forename: Raymond
authors.initials: R
authors.lastname: Koopmans
authors.forename: Chris
authors.initials: C
authors.lastname: van Weel
authors.forename: Paul
authors.initials: P
authors.lastname: Froeling
mesh_terms: 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