For professionals

Abstract

Objective
Little is known about the prevalence of persistent vegetative state/unresponsive wakefulness syndrome and comparisons between countries. The purpose of this column was to investigate the reasons for the similar number of patients in a vegetative state that were found in prevalence studies in nursing homes in 1 European country (the Netherlands) compared to a single European city (Vienna, Austria).

Design
The column is based on a literature review of the vegetative state in the Netherlands and Vienna in the period 2007-2008, in the context of professional interactions with families and doctors of patients in the vegetative state. In addition, families and doctors were interviewed in both countries to illustrate points of view.

Results
Similar between the 2 institutions are the population characteristics and the definition of, and criteria, for the vegetative state. A difference can be found in the development of authoritative policies in the Netherlands, after public debates and case law, which did not yet exist in Vienna at the time. There also appear to be different societal values related to rehabilitation and end-of-life decisions for patients in the vegetative state.

Discussion
The main explanation for the differences in vegetative state prevalence between the Netherlands and Vienna can be found in the different societal values about patients in the vegetative state and their treatment and rehabilitation. In the Netherlands, life-prolonging medical treatment, including artificial nutrition and hydration, is considered pointless and can be withdrawn if there is no prospect of recovery. In Vienna, however, patients in the vegetative state are considered severely disabled and in need of long-term rehabilitation and social reintegration. There is no discussion about the end of life in this context.

Keywords
Medical Ethics, Persistent Vegetative State, Prevalence, Rehabilitation, Unresponsive Wake Syndrome, Discontinuation of Treatment