L'alimentation artificielle et l'hydratation chez la personne en état végétatif chronique : soin, traitement ou acharnement thérapeutique ?

Progress in medicine and particularly in emergency medicine, intensive care, neurology and neurosurgery have enabled sustained life in an increasing number of patients with serious brain injuries. The life of persons who are in a chronic vegetative state is sustained by artificial nutrition and hydration. The question of whether these life-sustaining support systems should be continued or not is thus crucial. An analysis of the medical literature on the subject highlights the richness of the debate on this highly sensitive issue. The question has, however, been examined only partially and in many cases without sufficient rigor. It is true that the issue does not easily fit into the strict scientific structure required by evidence-based medicine. After having defined the notion of chronic vegetative state and the paucirelational status as well as the moral, philosophical and political issues involved (definition of life, meaning of life without consciousness, the sense of treatment, caregiver duties, rights of persons unable to express their will), this article discusses the information in the medical literature, which can be used to respond to several complex questions: what is the “status” of nutrition and hydration: care or treatment? What is our representation of nutrition and hydration, and eventual discontinuation in this context? It is licit to associate sedation with discontinuation of nutrition and hydration? What can be a basis for decision making concerning the limitation or interruption of nutrition and hydration for persons in the chronic vegetative state.