Nearly two-thirds of Americans think that someone in a persistent vegetative state can be saved by a miracle.

by Michael Smith, North American Correspondent, MedPage Today

HARTFORD, Conn., Aug. 18 — Nearly two-thirds of Americans think that someone in a persistent vegetative state can be saved by a miracle, researchers here have found.

But only a fifth of doctors agree, setting the stage for potential conflict between clinicians and patients, according to Lenworth Jacobs, M.D., of Hartford Hospital, and colleagues.

It’s just one of a series of end-of-life issues that find physicians and the public on different pages, Dr. Jacobs and colleagues reported in the August issue of Archives of Surgery.

The findings — from parallel surveys of the public and trauma specialists — pose “challenges for trauma professionals, hospital administrators, insurers, and society as a whole,” the researchers concluded.

Action Points 
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Explain to interested patients that differences between patients or their families and doctors over care, especially in an emergency situation, can lead to conflicts.

Note that this study, based on parallel surveys of the public and trauma professionals, outlines some major differences of opinion between professionals and the general public.

Those involved in end-of-life and trauma care need policies to cover difficult situations and training to allow them to deal effectively with members of the public, Dr. Jacobs said.

Without that, he said, “we’re going to be in conflict with people.”

For instance, he said, the issue of miracles and divine intervention is difficult for many caregivers, but it is a powerfully held belief for many people.

“We have to respect that,” he said. “If you just say that’s a crazy thing, it’s not going to work.”

For the analysis, the researchers conducted a random-digit-dialing telephone survey of 1,006 Americans over the age of 18. The margin of error was plus or minus 3.2 percentage points.

They also surveyed a convenience sample of medical personnel involved in trauma care, including medical directors of trauma units, trauma nurses, and emergency services personnel.

Among the findings:

  • The rate of emergency care is not much different among the public or professionals — 46.2% of the public and 47.4% of trauma professionals had received emergency treatment in the previous decade.
  • More than half (51.9%) of the public and 62.7% of professionals said they would like to be in the emergency department treatment area while an injured loved one was resuscitated.
  • Nearly three-quarters of the public — 72.4% — believe trauma patients have a right to demand care not deemed appropriate by a physician, compared with only 44.3% of professionals.
  • On the other hand, most of both groups said they would trust a physician’s decision to withdraw treatment when it would be futile. On a one-to-10 scale, where one is no trust and 10 is complete trust, the average score among the public was 7.0, compared with 9.4 among trauma professionals.
  • Professionals were more likely to have signed organ donor cards than the general public, at 78.9% versus 50.6%.
  • When making decisions about their own medical care, religious beliefs would be important to 41% of the public and 30.6% of professionals.
  • At the same time, 61.3% of the public and 20.2% of professionals believe that a miracle can save a person in a persistent vegetative state, and 57.4% of the public said divine intervention can save a person when doctors think treatment is futile, compared with just 19.5% of trauma professionals.

Interestingly, on the tough question of when to stop life-sustaining treatment, 72.8% of the public and 92.6% of professionals think if there’s no hope for recovery, the focus of care should shift to the comfort of the dying patients.

But among the minority who disagreed, 86.2% of the public and 33.3% of the professionals said treatment aimed at recovery should continue regardless of cost. On the other hand, when such aggressive care meant taking resources away from those with a better chance of life, members of the minority changed their minds — 56.1% of the public and 62.8% of the professionals said the care should cease.

The public survey was supported by the Aetna Foundation. The researchers made no financial disclosures.


Primary source: Archives of Surgery

Source reference: Jacobs LM et al. “Trauma Death: Views of the Public and Trauma Professionals on Death and Dying From Injuries” Arch Surg 2008; 143(8): 730-735.

Reviewed by Zalman S. Agus, MD; Emeritus Professor, University of Pennsylvania School of Medicine.

Published: August 18, 2008

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