title: Prevalence differences of patients in vegetative state in The Netherlands and Vienna, Austria: a comparison of values and ethics.
abstract: OBJECTIVE
  Little is known about prevalence of persistent vegetative state/unresponsive wakefulness syndrome and comparisons between countries. The aim of this column was to explore reasons for the comparable count of patients in vegetative state found in prevalence studies in nursing homes in 1 European country (Netherlands) compared with a single European city (Vienna, Austria).
  
  
  METHODS
  The column is based on a literature review of vegetative state in The Netherlands and Vienna in the period 2007-2008, in the context of professional interactions with families and physicians of patients in vegetative state. In addition, in both countries, families and physicians were interviewed to illustrate views.
  
  
  RESULTS
  Comparable between the 2 settings are the population characteristics and the definition of, and criteria, for vegetative state. A difference can be found in the development of authoritative policy guidelines in the Netherlands, after public debates and jurisdiction, which did not exist in Vienna at the time. There also seem to be different societal values concerning rehabilitation and end-of-life decisions for patients in vegetative state.
  
  
  CONCLUSIONS
  The most important explanation for the vegetative state prevalence differences between the Netherlands and Vienna can be found in the different societal values about patients in vegetative state and their treatment and rehabilitation. In the Netherlands, life prolonging medical treatment, including artificial nutrition and hydration, is considered futile and can be withdrawn if there is no prospect of recovery. In Vienna, however, patients in vegetative state are regarded as severely disabled and in need of long-term rehabilitation and social reintegration. There is no end-of-life discussion in this context.
authors.affiliation: Radboud University Nijmegen Medical Centre, the Netherlands (Drs Beljaars and Valckx); Neurologisches Zentrum OWS, Baumgartner Höhe, Vienna, Austria (Dr Stepan); Neurological Department, Apalliker Care Unit, Centre for Geriatrics am Wienerwald, Vienna, Austria (Dr Donis); and Department of Primary and Community Care: Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Nijmegen Medical Centre, the Netherlands (Dr Lavrijsen).
authors.forename: Daniëlle E A
authors.initials: DE
authors.lastname: Beljaars
authors.forename: Wilhelmina J A R M
authors.initials: WJ
authors.lastname: Valckx
authors.forename: Christoph
authors.initials: C
authors.lastname: Stepan
authors.forename: Johann
authors.initials: J
authors.lastname: Donis
authors.forename: Jan C M
authors.initials: JC
authors.lastname: Lavrijsen
mesh_terms: D001317:Austria / Q000453:epidemiology; D006801:Humans; D009426:Netherlands / Q000453:epidemiology; D009735:Nursing Homes / Q000941:ethics; D018458:Persistent Vegetative State / Q000453:epidemiology* / Q000628:therapy*; D015995:Prevalence; D012945:Social Values; D013727:Terminal Care / Q000941:ethics*