The opinions of health professionals with regard to the cessation of treatment given to ensure the survival of brain-damaged patients differ greatly between the North and South of Europe. Due to stronger religious beliefs, the countries of Southern Europe are much more reluctant to accept this issue. It was also established that men were more in favor of cessation of treatment than women and that the older the individual, the less inclined they were to be in favor.

Pain and end-of life

In January 2012, other results analysed by Athena Demertzi with collaboration with Pr. Eric Racine (McGill University and University of Montreal) were published in the journal Neuroethics ⁽³⁾, as well as in the researcher’s doctoral thesis: Ain't no rest for the brain. Neuroimaging and Neuroethics in dialogue for patients with disorders of consciousness. They dealt with questions relative to the issue of pain in patients with altered states of consciousness and the impact that opinions offered on this subject can have on end-of-life decisions.

First assessment: A majority of health professionals (56%) consider that patients in a vegetative state can feel pain. One of the factors that might explain this belief is the fact that there is some confusion between this state and the minimally conscious state, and all the more so because there was no distinction between the two states before the work of Joseph Giacino (2002). There is less controversy surrounding the minimally conscious state as behavioral data or data obtained by neuroimaging techniques has shown that patient’s brains react quite normally to nociceptive stimuli.

It was essential to determine to what extent the opinions relative to pain perception influenced the decision to cease artificial nutrition and hydration of patients in a vegetative or minimally conscious state. What did the statistics reveal? Among those health professionals persuaded that the vegetative state does not involve pain, a large majority (77%) was in favor of stopping life-maintenance treatment. This figure dropped to 59% among the group of professionals who were convinced of the sensitivity of the patients concerned to nociceptive stimuli. For the chronic minimally conscious state, willingness to stop treatment was much less as the figures were 38% and 29% respectively.

A general trend can therefore be established: the greater reluctance to “let the patient go” if he is adjudged to be capable of feeling pain. How can this strong surge of opinion be explained? It is still a matter of conjecture. One theory is that the ability to feel pain is associated with a more general sign of consciousness of the environment.

A double influence

By further analyzing the answers to the sample, Athena Demertzi demonstrates that profession and the fact of being a believer (without necessarily practicing) influenced the participants in the survey. Therefore, the non-believers in the sample show themselves to be much more favorable to cessation of treatment than believers regardless of whether the patient is believed to feel pain or not. Indeed, for the vegetative state, 69% of the non-believers believe it is appropriate to stop artificial nutrition and hydration when they think that the patient can feel pain and 86% when they think the opposite, while the figures for believers are 52% and 71% respectively. For the minimally conscious state, the percentages are low but the difference remains, 38% of the non-believers are in favor of stopping treatment if the patient feels pain, against 22% of believers. If the patient is adjudged to be incapable of nociceptive perceptions, the figures are 40% and 33% respectively.

(3) A. Demertzi, E. Racine, M.-A. Bruno, D. Ledoux, O. Gosseries, A. Vanhaudenhuyse, M. Thonnard, A. Soddu, G. Moonen, S. Laureys, Pain Perception in Disorders of Consciousness: Neuroscience (2012), Clinical Care, and Ethics in Dialogue, Neuroethics, 1-14.