Nutrition and hydration of patients in a persistent vegetative state

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Giorgia Viola Lacasella
Karidia Karaboue


Nutrition, Persistent Vegetative State, Bioethics


Entering a persistent vegetative state is undoubtedly devastating, as is its temporally unpredictable permanency. However, it is out of the question that the tragic nature of a pathological state such as PVS, however extreme, may in the slightest way alter the dignity of those affected nor their full rights. It is not possible to justify any denial or weakening of the right to care which should be guaranteed as for any other human being. Given the prominent number of people in a persistent vegetative state even in Italy, as well as the ongoing controversy over whether or not nutrition and hydration through a tube or percutaneous enterogastrostomy should be considered medical treatment and/or therapeutic intervention, it seems helpful to reiterate some fundamental bioethical principles.

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1. Conn MA. An incomplete death: Artificial hydration/ nutrition and the PVS patient. Theol Today 2019;76:158-166
2. Brown JE. The PVS patient. Linacre Q 2005;72:4
3. Karaboue MAA, Milone V, La Casella GV, et al. What will our children do when we are gone? Italian legislature does not tackle the worries of parents of disabled children. Reflections on disability. Medhistor [Internet] 2022;6:e2022013
4. Amella EJ, Lawrence JF, Gresle SO. Tube feeding: Prolonging life or death in vulnerable populations? Mortality 2005;10:69-81
5. Manning J. “Hospitals and clinicians need not apply:” Withdrawing clinically assisted nutrition and hydration in undisputed cases J Law Med 2019;26:538-548
6. Granata V, Morana G, D’onofrio M, et al. Structured reporting of computed tomography and magnetic resonance in the staging of pancreatic adenocarcinoma: A delphi consensus proposal. Diagnostics (Basel) 2021;11:2033
7. Kitzinger, C., Kitzinger J. Withdrawing artificial nutrition and hydration from minimally conscious and vegetative patients: Family perspectives. J Med Ethics 2015;41:157-60
8. Bernetti A, La Russa R, De Sire A, et al. Cervical Spine Manipulations: Role of Diagnostic Procedures, Effectiveness, and Safety from a Rehabilitation and Forensic Medicine Perspective: A Systematic Review. Diagnostics (Basel) 2022;12:1056
9. Matsuoka H, Tochio T, Watanabe A, et al. The Effects of Enteral Nutrition on the Intestinal Environment in Patients in a Persistent Vegetative State Foods 2022;11:549
10. Cantisani V, Iannetti G, Miele V, et al. Addendum to the sonographic medical act. J Ultrasound 2021;24:229-230
11. Henke DE. Persistent unconsciousness and the use of assisted nutrition and hydration: Medical and moral reflections Linacre Q 2011;78:138-156
12. Pastorini A, Karaboue M, Di Luca A, Mario di Luca NM, Ciallella C. Medico-legal aspects of tort law patient safeguards within the Gelli-Bianco piece of legislation. Clin Ter 2018;169:170-177
13. Hamel RP, Walter JJ. Artificial nutrition and hydration and the permanently unconscious patient. The catholic debate. Georgetown University press; 2007
14. Giaconi, C, Manetti AC, Turco S, et al. Post-mortem computer tomography in ten cases of death while diving: a retrospective evaluation. Radiol Med 2022;127:318-329
15. Shannon TA, Walter JJ. The PVS patient and the forgoing/withdrawing of medical nutrition and hydration. Theol Stud 1988;49:623-47
16. Luchetti M. The permanent vegetative state or an enduring state of death. Acta Anaesthesiologica Italica 2008;/ Anaesthesia and Intensive Care in Italy 59(2), pp. 124-137 ISSN 11248882
17. Raspini M, Cavalcanti R, Clementini M, et al. Periodontitis and italians (2016-2020): Need for clinical guidelines to perform effective therapy. Dental Cadmos 2021;89:346–356
18. Mitchell KR, Kerridge IH, Lovat TJ Medical futility, treatment withdrawal and the persistent vegetative state. J Med Ethics 1993;19:71-76
19. Mazzariol B, Karaboue M, Di Luca A, Di Luca NM. Guidelines, good practices and best clinical health practices: Valuable guidance for physicians and judges? Clin Ter 2018;169:E292–E296
20. Van De Vathorst S. Artificial nutrition at the end of life: Ethical issues. Best Pract Res Clin Gastroenterol 2014;28:247-253
21. Fiorini F, Granata A, Battaglia Y, Karaboue MAA. Talking about medicine through mass media G Ital Nefrol 2019;36:2019
22. Constable C. Withdrawal of artificial nutrition and hydration for patients in a permanent vegetative state: Changing tack, 2012, Bioethics 2012;26:157-163