title: The Eluana Englaro Case: cause of death after the withdrawal of artificial nutrition and hydration in a subject in a permanent vegetative state and with quadriplegia.
abstract: A 38-year-old woman, who had been in a permanent vegetative state with quadriplegia for 17 years following a motor vehicle accident, died 87 h after the judicially authorised suspension of artificial nutrition and hydration. Medico-legal investigations, requested by the Judicial Authorities and focusing on the evaluation of clinical and necroscopic data, aimed to explain the cause of death, to exclude any lethal cause other than one deriving from the withdrawal of artificial nutrition and hydration and to verify the level of perceived discomfort and the correctness in the application of the supportive protocol during the end of life phase. The inability of quadriplegic patients to compensate critical hyperthermic and haemodynamic disturbances induced by dehydration was considered to be the cause of a rapid demise after the withdrawal of artificial sustenance.
authors.affiliation: Department of Medical and Biological Sciences, Section of Forensic Medicine, University of Udine, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Moreschi
authors.forename: Ugo
authors.initials: U
authors.lastname: Da Broi
authors.forename: Daniele
authors.initials: D
authors.lastname: Rodriguez
authors.forename: Rino
authors.initials: R
authors.lastname: Froldi
authors.forename: Andrea
authors.initials: A
authors.lastname: Porzionato
authors.forename: Veronica
authors.initials: V
authors.lastname: Macchi
authors.forename: Raffaele
authors.initials: R
authors.lastname: De Caro
mesh_terms: D000328:Adult; D001002:Anuria / Q000209:etiology; D001831:Body Temperature; D001919:Bradycardia / Q000209:etiology; D001921:Brain / Q000473:pathology; D004231:Diuresis; D005260:Female; D005334:Fever / Q000209:etiology; D005440:Fluid Therapy; D049429:Forensic Pathology; D006323:Heart Arrest / Q000209:etiology; D006801:Humans; D007022:Hypotension / Q000209:etiology; D007558:Italy; D009093:Mucus / Q000378:metabolism; D009206:Myocardium / Q000473:pathology; D018529:Nutritional Support; D009846:Oliguria / Q000209:etiology; D018458:Persistent Vegetative State; D011782:Quadriplegia; D012137:Respiratory System / Q000473:pathology; D012798:Sialorrhea / Q000209:etiology; D013546:Sweating; D028761:Withholding Treatment / Q000331:legislation & jurisprudence
keywords: Permanent vegetative state; Quadriplegia; Withdrawal of artificial hydration; Withdrawal of artificial nutrition