Talking to comatose patients
J. La Puma, D. L. Schiedermayer, A. E. Gulyas and M. Siegler
Center for Clinical Medical Ethics, Department of Medicine, University of Chicago Hospitals and Clinics, IL.
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 self-fulfilling
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.
