Physicians' Attitudes about the Care of Patients in the Persistent Vegetative State: A National Survey

Kirk Payne, Robert M. Taylor, Carol Stocking, Greg A. Sachs

Research output: Contribution to journalReview article

94 Citations (Scopus)

Abstract

Objective: To study the attitudes and beliefs of physicians who have experience caring for patients in the persistent vegetative state (PVS). Design: Mailed questionnaire survey. Participants: 500 physicians, 250 from the American Academy of Neurology and 250 from the American Medical Directors Association. Measurements: 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.

Original languageEnglish (US)
Pages (from-to)104-110
Number of pages7
JournalAnnals of internal medicine
Volume125
Issue number2
DOIs
StatePublished - Jul 15 1996

Fingerprint

Persistent Vegetative State
Patient Care
Physicians
Capital Punishment
Physician Executives
Therapeutics
Thirst
Tissue and Organ Procurement
Hunger
Cardiogenic Shock
Surveys and Questionnaires
Kidney Neoplasms
Psychological Stress
Acute Kidney Injury
Respiratory Insufficiency
Consensus
Transplantation
Pain
Health

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Physicians' Attitudes about the Care of Patients in the Persistent Vegetative State : A National Survey. / Payne, Kirk; Taylor, Robert M.; Stocking, Carol; Sachs, Greg A.

In: Annals of internal medicine, Vol. 125, No. 2, 15.07.1996, p. 104-110.

Research output: Contribution to journalReview article

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abstract = "Objective: To study the attitudes and beliefs of physicians who have experience caring for patients in the persistent vegetative state (PVS). Design: Mailed questionnaire survey. Participants: 500 physicians, 250 from the American Academy of Neurology and 250 from the American Medical Directors Association. Measurements: 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.",
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