Physicians' attitudes toward medical and ethical challenges for patients in the vegetative state: comparing Canadian and German perspectives in a vignette survey

Background: Physicians treating patients in the vegetative state
(VS) must deal with uncertainty in diagnosis and prognosis, as well
as ethical issues. We examined whether physicians' attitudes toward
medical and ethical challenges vary across two national medical
practice settings. Methods: A comparative survey was conducted
among German and Canadian specialty physicians, based on a case
vignette about the VS. Similarities and differences of
participants' attitudes toward medical and ethical challenges
between the two samples were analyzed with non-parametric tests
(Mann-Whitney-U-Test). Results: The overall response rate was
13.4%. Eighty percent of all participants correctly applied the
diagnostic category of VS with no significant differences between
countries. Many of the participants who chose the correct diagnosis
of VS attributed capabilities to the patient, particularly the
ability to feel pain (70%), touch (51%) and to experience hunger
and thirst (35%). A large majority of participants (94%) considered
the limitation of life-sustaining treatment (LST) under certain
circumstances, but more Canadian participants were in favor of
always limiting LST (32% vs. 12%; Chi-square: p < 0.001).
Finding long-term care placement was considered more challenging by
Canadian participants whereas discontinuing LST was much more
challenging for German participants. Conclusions: Differences were
found between two national medical practice settings with respect
to physicians' experiences and attitudes about treatment limitation
about VS in spite of comparable diagnostic knowledge.