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Attitudes towards end-of-life issues in disorders of consciousness: a European survey.
[locked-in syndrome]
Previous
European
surveys
showed
the
support
of
healthcare
professionals
for
treatment
withdrawal
[
i
.
e
.
,
artificial
nutrition
and
hydration
(
ANH
)
in
chronic
vegetative
state
(
VS
)
patients
]
.
The
recent
definition
of
minimally
conscious
state
(
MCS
)
,
and
possibly
research
advances
(
e
.
g
.
,
functional
neuroimaging
)
,
may
have
lead
to
uncertainty
regarding
potential
residual
perception
and
may
have
influenced
opinions
of
healthcare
professionals
.
The
aim
of
the
study
was
to
update
the
end-of-life
attitudes
towards
VS
and
to
determine
the
end-of-life
attitudes
towards
MCS
.
A
16
-
item
questionnaire
related
to
consciousness
,
pain
and
end-of-life
issues
in
chronic
(
i
.
e
.
,
>
1
year
)
VS
and
MCS
and
locked-
in
syndrome
was
distributed
among
attendants
of
medical
and
scientific
conferences
around
Europe
(
n
=
59
)
.
During
a
lecture
,
the
items
were
explained
orally
to
the
attendants
who
needed
to
provide
written
yes
/
no
responses
.
Chi
-square
tests
and
logistic
regression
analyses
identified
differences
and
associations
for
age
,
European
region
,
religiosity
,
profession
,
and
gender
.
We
here
report
data
on
items
concerning
end-of-life
issues
on
chronic
VS
and
MCS
.
Responses
were
collected
from
2
,
475
participants
.
For
chronic
VS
(
>
1
year
)
,
66
%
of
healthcare
professionals
agreed
to
withdraw
treatment
and
82
%
wished
not
to
be
kept
alive
(
P
<
0
.
001
)
.
For
chronic
MCS
(
>
1
year
)
,
less
attendants
agreed
to
withdraw
treatment
(
28
%
,
P
<
0
.
001
)
and
wished
not
to
be
kept
alive
(
67
%
,
P
<
0
.
001
)
.
MCS
was
considered
worse
than
VS
for
the
patients
in
54
%
and
for
their
families
in
42
%
of
the
sample
.
Respondents
'
opinions
were
associated
with
geographic
region
and
religiosity
.
Our
data
show
that
end-of-life
opinions
differ
for
VS
as
compared
to
MCS
.
The
introduction
of
the
diagnostic
criteria
for
MCS
has
not
substantially
changed
the
opinions
on
end-of-life
issues
on
permanent
VS
.
Additionally
,
the
existing
legal
ambiguity
around
MCS
may
have
influenced
the
audience
to
draw
a
line
between
expressing
preferences
for
self
versus
others
,
by
implicitly
recognizing
that
the
latter
could
be
a
step
on
the
slippery
slope
to
legalize
euthanasia
.
Given
the
observed
individual
variability
,
we
stress
the
importance
of
advance
directives
and
identification
of
proxies
when
discussing
end-of-life
issues
in
patients
with
disorders
of
consciousness
.
Diseases
Validation
Diseases presenting
"minimally conscious state"
symptom
locked-in syndrome
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