• Jan Lavrijsen, Hans van den Bosch, Raymond Koopmans, Chris van Weel, and Paul Froeling.
• 'De Zorgboog' Nursing Homes, Bakel, The Netherlands. j.lavrijsen@vphg.umcn.nl
• Brain Inj. 2005 Jan 1;19(1):67-75.

ObjectiveTo clarify characteristics of long-term care and treatment of patients in a vegetative state.DesignQualitative, descriptive study in a Dutch nursing home.MethodsReview of clinical records of patients in a vegetative state after acute brain damage between 1978-2002.ResultsFive patients received intensive care of a multi-disciplinary team and showed considerable co-morbidity. There was no standard scenario for end-of-life decisions. Physicians play a more proactive role by evaluating the total medical treatment instead of withholding therapy in case of incidental complications. The families' attitude is a crucial factor in their ultimate decision.ConclusionsThere is no standard solution to alleviate the fate of patients in a vegetative state and their families. Withdrawing all medical treatment, including artificial nutrition and hydration, can be an acceptable scenario for letting the patient die. More research is needed to identify the factors that contribute to acceptance of the physician's decision by the family.

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