A conflict of opinions that raises some questions

In 2011, we released the first results of a major survey conducted between September 2007 and October 2009 among more than 2000 European health professionals – around two-thirds of these were doctors and a third were members of the paramedical sector. At the end of each conference or scientific congress which took part during this period, Steven Laureys asked the participants to answer a series of questions which were then analyzed by Doctor Athena Demertzi, a neuropsychologist and member of his team. “At first, the individuals questioned received detailed information about these particular altered states of consciousness, which we wrote about in 2011 (see article: The ethics of death). They were then requested to answer yes or no to the questions asked. To ensure a more precise interpretation of the results, five demographic details were gathered for each participant: age, sex, nationality (32 countries spread across 3 geographical zones- Northern, Central and Southern Europe), profession and religious beliefs or more exactly whether they believed in God or not and adhered to an institutionalized religion (Christianity, Islam, Judaism…) without necessarily practicing”.

Published in the Journal of Neurology⁽²⁾, the results which we already knew from 2011 taught us that 66% of the individuals questioned, adjudged that it was acceptable to stop treatment (artificial nutrition and hydration) for patients in a chronically vegetative state, that is to say those patients who were in this state for more than one year and hence considered chronic. However, only 28% of them thought that this measure was justified when it concerned patients who were in a chronic minimally conscious state.

Two other questions concerned what patients would like to be done to them if they were themselves in a chronically vegetative or minimally conscious state. In the first case (VS), only 18% of the people asked (19% of doctors and 12% of paramedical personnel) would like to be kept alive and, in the second case (MCS), 33% (35% of doctors and 24% of paramedical personnel). The work of Athena Demertzi therefore revealed a conflict between how health professionals would like to be treated and what they would recommend for others. This certainly raises a lot of questions. According to Steven Laureys, fear of litigation and reservations linked to the irreversibility of death probably go a long way towards explaining these statistics. As far as he is concerned, the medical authorities should redress this imbalance. “It is neither moral nor ethical to deny to others rights that we grant to ourselves”, he points out.

What did the last two questions that were analysed in 2011 reveal? Firstly, that 80% of the individuals questioned felt that it would be worse for a family to have one of its members in a vegetative state than to be dead, also, 55% of the sample considered that it would be better to die than to survive in this unconscious state. These percentages are easy to understand to the extent that, when deprived of consciousness, the patient in a vegetative state does not suffer like his family. Secondly: if we put ourselves in the place of the patient, the minimally conscious state is worse than the vegetative state in the eyes of 54% of the individuals in the sample; however, if we put ourselves in the place of the family, this opinion is only shared by 42% of the individuals questioned. “Some families content themselves with some signs of residual consciousness such as a smile given to a mother or father”, Steven Laureys offers as an explanation for these figures.

(2) A. Demertzi, D. Ledoux, M.-A. Bruno, A. Vanhaudenhuyse, O. Gosseries, A. Soddu, C. Schnakers, G. Moonen, S. Laureys, Attitudes towards end-of—life issues in disorders of consciousness : a European survey, J. Neurol, 2011.