“Intolerable” delays attend withdrawal of life support for patients in permanent vegetative state

“Intolerable” delays often attend the withdrawal of life support for patients in a permanent vegetative state (PVS), conclude experts in the Journal of Medical Ethics.

Professors Jenny Kitzinger of Cardiff University and Celia Kitzinger of York University illustrate some of the common difficulties arising in these situations in a recent case of a young woman who was put on life support after sustaining a catastrophic brain injury from which she never regained consciousness in 2012.

They became involved after the woman’s mother pleaded with them in 2015 to help her get a court hearing for the withdrawal of life support.

This was finally done in May 2016, almost four years after the woman’s injury. This time lag was despite the best efforts of her family to stop treatment to prolong her life that they believed she would not have wanted - and which was not in her best interests - and despite the fact that a diagnosis of PVS could have been reached in early 2013.

“The length of time this case took to be resolved is sadly rather typical of many cases that go through the courts,” say the authors. They point out that many of the factors causing the delays in this case, such as gathering medical records and statements from across different organisations, are common to others.

“The costs of continuing to give treatment that is not in the patient’s best interests (and which the family believes the patient would not want) are huge, both financially and ethically,” they write.

The cost of keeping each PVS patient alive is around £90 000 a year. But this excludes the legal bills for the NHS and the cost of legal aid for the family - money that could be spent instead on patients who would benefit from treatment, they say.

It is widely acknowledged that keeping patients in PVS alive - regardless of their prior expressed wishes - is problematic, and the system needs to change, they argue.

“We suggest that the single most effective way of addressing the problem of ‘avoidable delays’ in withdrawing unwanted/futile treatment from existing PVS patients would be to abolish the (perceived) need for a court hearing in cases where there is general agreement (as in the case examined here) as to the patient’s best interests,” they write.