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Prevalence Differences of Patients in Vegetative State in the Netherlands and Vienna, Austria: A Comparison of Values and Ethics

Beljaars, Daniëlle E. A. MD; Valckx, Wilhelmina J. A. R. M. MD; Stepan, Christoph MD, PhD; Donis, Johann MD; Lavrijsen, Jan C. M. MD, PhD

The Journal of Head Trauma Rehabilitation: May/June 2015 - Volume 30 - Issue 3 - p E57–E60
doi: 10.1097/HTR.0000000000000058
Original Articles

Objective: Little is known about prevalence of persistent vegetative state/unresponsive wakefulness syndrome and comparisons between countries. The aim of this column was to explore reasons for the comparable count of patients in vegetative state found in prevalence studies in nursing homes in 1 European country (Netherlands) compared with a single European city (Vienna, Austria).

Design: The column is based on a literature review of vegetative state in the Netherlands and Vienna in the period 2007-2008, in the context of professional interactions with families and physicians of patients in vegetative state. In addition, in both countries, families and physicians were interviewed to illustrate views.

Results: Comparable between the 2 settings are the population characteristics and the definition of, and criteria, for vegetative state. A difference can be found in the development of authoritative policy guidelines in the Netherlands, after public debates and jurisdiction, which did not exist in Vienna at the time. There also seem to be different societal values concerning rehabilitation and end-of-life decisions for patients in vegetative state.

Discussion: The most important explanation for the vegetative state prevalence differences between the Netherlands and Vienna can be found in the different societal values about patients in vegetative state and their treatment and rehabilitation. In the Netherlands, life prolonging medical treatment, including artificial nutrition and hydration, is considered futile and can be withdrawn if there is no prospect of recovery. In Vienna, however, patients in vegetative state are regarded as severely disabled and in need of long-term rehabilitation and social reintegration. There is no end-of-life discussion in this context.

Radboud University Nijmegen Medical Centre, the Netherlands (Drs Beljaars and Valckx); Neurologisches Zentrum OWS, Baumgartner Höhe, Vienna, Austria (Dr Stepan); Neurological Department, Apalliker Care Unit, Centre for Geriatrics am Wienerwald, Vienna, Austria (Dr Donis); and Department of Primary and Community Care: Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Nijmegen Medical Centre, the Netherlands (Dr Lavrijsen).

Corresponding Author: Wilhelmina J. A. R. M. Valckx, MD, Radboud University Nijmegen Medical Centre, Radboud, Nijmegen, Gelderland, The Netherlands ( or

Danielle E.A. Beljaars and Wilhelmina J.A.R.M. Valckx equally contributed.

The study was conducted as a research internship of the first 2 authors when they were in the medical school. A scholarship for this internship was received from the Erasmus Programme.

The authors thank the families and physicians they interviewed. Moreover, they also thank the staff of the “Otto Wagner Hospital, Neurological Centre Maria-Theresien-Schlössel,” “Neurological department with Apalliker Care Unit, Centre for Geriatrics am Wienerwald,” and “Haus der Barmherzigkeit” for their hospitality and especially Professor H. Binder of the Otto Wagner Spital for tutoring the first 2 authors during their stay in Vienna, Austria.

The authors declare no conflicts of interest.

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