SURVEY OF BRITISH CLINICIAN VIEWS ON MANAGEMENT OF PATIENTS IN PERSISTENT VEGETATIVE STATE

Background The best care and management of patients in persistent vege tative slate (PVS) has been the subject of sustained moral and legal d ebate for a number of years. However, the views of clinicians in the U K involved in caring for patients in PVS are largely unknown. Methods A postal questionnaire was sent to 1882 consultant members of the Brit ish Association of Orthopaedic Surgeons, the Association of British Ne urologists, the Society of British Neurosurgeons, and the British Soci ety of Rehabilitation Medicine. Their views were sought on various asp ects of the management and care of PVS, in particular the appropriaten ess of a decision not to treat and a decision to withdraw artificial n utrition and hydration (ANH). Findings 1027 doctors responded (55%) of whom 558 (54%) had experience of managing patients in PVS. Over 90% o f responding doctors considered that it could be not to treat acute in fections and other life-threatning conditions. 65% of doctors consider ed that withdrawal of ANH could be apporpriate. About two-thirds of do ctors who thought treatment-limiting decisions could be appropriate th ought that such decisions could be considered with the first 12 months of the patient being in PVS. Despite recent case law, less than half the doctors responding to the survey thought that an advance directive made by the patient should have a decisive influence in determining t reatment-limiting decisions. Most doctors would like decisions about w ithdrawing ANH to be made in conjunction with family members and in ac cordance with agreed guidelines but without the need to go to court. I nterpretation There is a broad consensus among doctors that treatment- limiting decisions are sometimes appropriate for patients in PVS, irre spective of whether they have experience of the condition or of the sp ecialty to which they belong. However, two thirds of doctors said that such decisions can be considered al a time earlier than that recommen ded by the British Medical Association. It is not clear why some docto rs thought a decision not to treat could be appropriate while a decisi on to withdraw ANH would not be.