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Nonconsensual withdrawal of nutrition and hydration in prolonged disorders of consciousness: authoritarianism and trustworthiness in medicine

Overview of attention for article published in Philosophy, Ethics, and Humanities in Medicine, January 2014
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About this Attention Score

  • In the top 25% of all research outputs scored by Altmetric
  • Among the highest-scoring outputs from this source (#44 of 199)
  • High Attention Score compared to outputs of the same age (91st percentile)

Mentioned by

blogs
1 blog
twitter
10 tweeters

Citations

dimensions_citation
12 Dimensions

Readers on

mendeley
66 Mendeley
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Title
Nonconsensual withdrawal of nutrition and hydration in prolonged disorders of consciousness: authoritarianism and trustworthiness in medicine
Published in
Philosophy, Ethics, and Humanities in Medicine, January 2014
DOI 10.1186/1747-5341-9-16
Pubmed ID
Authors

Mohamed Y Rady, Joseph L Verheijde

Abstract

The Royal College of Physicians of London published the 2013 national clinical guidelines on prolonged disorders of consciousness (PDOC) in vegetative and minimally conscious states. The guidelines acknowledge the rapidly advancing neuroscientific research and evolving therapeutic modalities in PDOC. However, the guidelines state that end-of-life decisions should be made for patients who do not improve with neurorehabilitation within a finite period, and they recommend withdrawal of clinically assisted nutrition and hydration (CANH). This withdrawal is deemed necessary because patients in PDOC can survive for years with continuation of CANH, even when a ceiling on medical care has been imposed, i.e., withholding new treatment such as cardiopulmonary resuscitation for acute life-threatening illness. The end-of-life care pathway is centered on a staged escalation of medications, including sedatives, opioids, barbiturates, and general anesthesia, concurrent with withdrawal of CANH. Agitation and distress may last from several days to weeks because of the slow dying process from starvation and dehydration. The potential problems of this end-of-life care pathway are similar to those of the Liverpool Care Pathway. After an independent review in 2013, the Department of Health discontinued the Liverpool Care pathway in England. The guidelines assert that clinicians, supported by court decisions, have become the final authority in nonconsensual withdrawal of CANH on the basis of "best interests" rationale. We posit that these guidelines lack high-quality evidence supporting: 1) treatment futility of CANH, 2) reliability of distress assessment from starvation and dehydration, 3) efficacy of pharmacologic control of this distress, and 4) proximate causation of death. Finally, we express concerns about the utilitarian-based assessment of what constitutes a person's best interests. We are disturbed by the level and the role of medical authoritarianism institutionalized by these national guidelines when deciding on the worthiness of life in PDOC. We conclude that these guidelines are not only harmful to patients and families, but they represent the means of nonconsensual euthanasia. The latter would constitute a gross violation of the public's trust in the integrity of the medical profession.

Twitter Demographics

The data shown below were collected from the profiles of 10 tweeters who shared this research output. Click here to find out more about how the information was compiled.

Mendeley readers

The data shown below were compiled from readership statistics for 66 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
United States 1 2%
Unknown 65 98%

Demographic breakdown

Readers by professional status Count As %
Student > Bachelor 11 17%
Researcher 10 15%
Student > Ph. D. Student 9 14%
Student > Master 8 12%
Student > Doctoral Student 6 9%
Other 12 18%
Unknown 10 15%
Readers by discipline Count As %
Medicine and Dentistry 23 35%
Psychology 7 11%
Nursing and Health Professions 6 9%
Social Sciences 5 8%
Philosophy 4 6%
Other 9 14%
Unknown 12 18%

Attention Score in Context

This research output has an Altmetric Attention Score of 17. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 24 January 2018.
All research outputs
#1,341,434
of 17,361,274 outputs
Outputs from Philosophy, Ethics, and Humanities in Medicine
#44
of 199 outputs
Outputs of similar age
#21,065
of 240,208 outputs
Outputs of similar age from Philosophy, Ethics, and Humanities in Medicine
#1
of 1 outputs
Altmetric has tracked 17,361,274 research outputs across all sources so far. Compared to these this one has done particularly well and is in the 92nd percentile: it's in the top 10% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 199 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 13.4. This one has done well, scoring higher than 78% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 240,208 tracked outputs that were published within six weeks on either side of this one in any source. This one has done particularly well, scoring higher than 91% of its contemporaries.
We're also able to compare this research output to 1 others from the same source and published within six weeks on either side of this one. This one has scored higher than all of them