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John La Puma, MD; David L. Schiedermayer, MD; Ann E. Gulyas, MA; Mark Siegler, MD

Arch Neurol. 1988;45(1):20-22.

Abstract
• Physicians may not talk to comatose patients for several reasons. Comatose patients do not seem to hear or respond. Speaking may not affect their clinical outcome; time spent with them takes time away from other, more "viable" patients. Comatose patients may, however, hear; many have normal brain-stem auditory evoked responses and normal physiologic responses to auditory stimuli. Not talking to comatose patients may promote the notion that they are dead or nearly dead; not talking may become a selffulfilling prophecy, influencing physicians to inappropriately withhold or withdraw therapy. Because comatose patients are especially vulnerable, and because some comatose patients may recover, physicians should consider talking to these patients. Our analysis suggests that families, medical students, and house staff would benefit from the humane example modeled by those clinicians who care for and talk to all patients.

Author Affiliations
From the Center for Clinical Medical Ethics, Section of General Internal Medicine, Department of Medicine (Drs La Puma, Schiedermayer, and Siegler) and the Center for Speech and Swallowing Disorders, Section of Otolaryngology, Department of Surgery (Ms Gulyas), The University of Chicago Hospitals and Clinics. Dr La Puma is now with The Section of Clinical Ethics, Lutheran General Hospital, Park Ridge, Ill.

Footnotes
Accepted for publication May 20, 1987.

Reprint requests to The Section of Clinical Ethics, Lutheran General Hospital, 1775 Dempster, Park Ridge, IL 60068 (Dr La Puma).

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