Survey of Japanese physicians' attitudes towards the care of adult patients in persistent vegetative state

Objectives-Ethical issues have recently been raised regarding the appropria te care of patients in persistent vegetative state (PVS) in Japan. The purp ose of our study is to study the attitudes and beliefs of Japanese physicia ns who have experience caring for patients in PVS. Design and setting-A postal questionnaire was sent to all 317 representativ e members of the Japan Society, of Apoplexy working at university hospitals or designated teaching hospitals by, the Ministry of Health and Welfare. T he questionnaire asked subjects what they would recommend for three hypothe tical vignettes that varied with respect to a PVS patient's previous wishes and the wishes of the family. Results-The response rate was 65%. fn the case of a PVS patient who had no previous expressed wishes and no family, 3% of the respondents would withdr aw artificial nutrition and hydration (ANH) when the patient did not requir e any other life-sustaining treatments, 4% would discontinue ANH, and 30% w ould withhold antibiotics when the patient developed pneumonia. Significant ly more respondents (17%) would withdraw ANH in the case of a PVS patient w hose previous wishes and family agreed that all life support be discontinue d. Most respondents thought that a patient's written advance directives wou ld influence their decisions. Forty per cent of the respondents would want to have ANH stopped and 31% would not want antibiotics administered if they were in PVS. Conclusions-Japanese physicians tend nor to withdraw ANH from PVS patients. Patients' written advance directives, however, would affect their decision s.