Duty of Care to the Unconscious Patient - Approaching the Controversies of the Persistent Vegetative State by Fulfilling the Physician's Duty of Care (P07.274)

Abstract

Objective: This article explains the contemporary challenges in managing the persistent vegetative state (PVS) and suggests an approach to the PVS. Background The PVS was first described as 9the syndrome without a name9 in 1972 and has been a source of confusion in diagnosis. It is difficult to determine prognosis. Multiple dilemmas exist in managing the patient. Extrinsic factors include cultural perceptions and media distortions. Design/Methods: By local at examples in the West, this article recognizes the ethical, philosophical and emotional dilemmas that both physicians and family face. With the motivation of affirming the right to care while respecting the right to die, the author discusses the appropriateness of the withdrawal of care by addressing the concept of medical futility and principles of medical ethics. Results: Management should be defined by the best interests of the patient and physician9s duty of care. Duty of care is achieved through neuro-palliative care that seeks to maximize quality end-of-life care for patients and families – where care is meant to affirm life and regard dying as a normal process, intending to neither hasten to postpone death and integrates psychological and spiritual aspects of patient care. Conclusions: With the prerequisites of diagnostic rigor, good communication and fulfillment of duty of care, the medical profession is in the best position to direct the care of such patients and deserves the trust and mandate of society to practice. Current doctors practicing in morally ambivalent cultures may not have the luxury of time or resources nor the extraordinary courage needed to contemplate these issues solitarily. Through the reinforcement of this deontological obligation to practice with sound science and respect for human dignity, affirming the right to care while respecting the right to die may be achieved by every doctor, and not just the morally courageous ones. Disclosure: Dr. Goh has nothing to disclose.