BELGIAN DOCTORS ATTITUDES ON THE MANAGEMENT OF PATIENTS IN PERSISTENTVEGETATIVE STATE (PVS) - ETHICAL AND REGULATORY ASPECTS

Background The best care and management of patients in persistent vege tative state (PVS) has been the subject of sustained moral and legal d ebate for a number of years. However, the views of specialist doctors in Belgium involved in the care for patients in PVS are largely unknow n. Methods. A postal questionnaire was sent to 403 members of Belgian Societies of Neurosurgeons, Neurologists and Rehabilitation Doctors. T heir views were sought on various aspects of the management and care o f PVS, focusing on the issue of the appropriateness of non-treatment a nd the withdrawal of artificial feeding. Findings. Of the 208 doctors who completed the questionnaires (52%), 172 (83%) indicated that they had been involved in the management of a patient in PVS. 88% of the re sponding doctors thought it was sometimes appropriate not to treat acu te infections or other life-threatening conditions in a PVS patient. F ifty-six percent considered it sometimes appropriate to withdraw artif icial feeding. About three-quarter of physicians who considered both t reatment-limiting decisions appropriate thought that such decisions co uld be considered within the first year of the patient being in PVS. F orty per cent accorded a decisive influence to an advance directive an d only a small number of doctors considered the influence of the patie nt's family in the decision to withdraw artificial feeding as decisive . Over 80% of the clinicians disagreed with the view that each decisio n about withdrawing artificial nutrition and hydration (ANH) should co me before the courts. Interpretation. Doctors in Belgium seem to be mo re reluctant to withdraw artificial feeding than not to treat acute in fections or other life-threatening conditions in PVS. The reason for t his difference appeared to be connected with the moral as well as with the clinical content of the decision. The broad variety of answers on the interval when the vegetative state is to be regarded as permanent and when treatment-limiting decisions are appropriate, could be due t o the lack of official guidelines in Belgium. There seems however to b e no consensus about a future policy in Belgium for making decisions a bout the withdrawal of ANH.