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Withdrawal of clinically assisted nutrition and hydration decisions in patients with prolonged disorders of consciousness: best interests of the patients and advance directives are the keys
  1. N Lejeune1,2
  1. 1Coma Science Group, GIGA research, University of Liège, Liège, Belgium
  2. 2Disorders Of Consciousness Care Unit, Centre Hospitalier Neurologique William Lennox, Catholic University of Louvain, Ottignies-Louvain-la-Neuve, Belgium
  1. Correspondence to Dr Nicolas Lejeune, Disorders Of Consciousness Care Unit, Centre Hospitalier Neurologique William Lennox, Allée de Clerlande 6, Ottignies-Louvain-la-Neuve 1340, Belgium; nicolas.lejeune{at}chnwl.be

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Comment on: “Back to the bedside? Making clinical decisions in patients with prolonged unconsciousness” (Wade, D.) & “Can ‘Best Interests’ derail the trolley? Examining withdrawal of clinically assisted nutrition and hydration in patients in the permanent vegetative state” (Fritz, Z.)

In this issue of the journal, Dr Fritz and Dr Wade raise the controversial issue of the withdrawal of clinically assisted nutrition and hydration (CANH) in patients with disorders of consciousness (DOC).1 ,2

Dr Fritz, in an elegant demonstration, illustrates how it could be in the best interests (referring also to the Best Interest procedure as described in the Mental Capacity Act)3 of the patient to stop his life promptly (ie, by injection of lethal drugs) to save another patient's life through organ donation rather than considering withdrawal of CANH. Although the underlying reasoning is very relevant, I would like to point out that we are here dealing with several issues that the author might have mixed up. First, we are questioning the patient's right to an autonomous choice around organ donation and their right to refuse or to withdraw medical treatments. Moreover, although a special focus was made on patients with DOC, we are clearly questioning the more general and touchy subject of organ donation from …

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