[Vegetative state and over-treatment: what families think of it]

With the notable advances made in all branches of medicine doctors are now increasingly faced with issues no longer of a purely clinical nature but of an ethical and moral nature. Chronic diseases, terminal conditions, and the vegetative state are just some of the many examples of clinical conditions that impose on health professionals the need to reflect (and make decisions?) on ethical matters. The instruments that medicine places in the hands of the health professional must lead them to reflect not only on the clinical validity of a choice but also on how opportune it is to undertake a given intervention, on the proportionality of the intervention. There is an increasing need to calibrate interventions between 'opportune' and 'excessive'. To do this, technical expertise is not sufficient; other factors come into play that are more personal and difficult to standardize concerning the meaning itself of life and its quality. Alongside the technical-scientific opinions of the medical professional, the voice of family members must also be taken into account. A voice whose tone is deepened by the burden of caring, by the painful situation they are experiencing, by the difficulty of understanding a technical language they are not conversant with. The present study is a preliminary investigation carried out on 32 family caregivers of patients in minimally responsive or vegetative states in either long-term hospital structures or home care. Family caregivers were investigated concerning their understanding of the concept of over-treatment and which aspects of the patient's daily life could, in their opinion, be considered as over-treatment. Findings show that the concept of over-treatment is not well understood by families, even if almost all subjects declared to be contrary to over-treatment. Considering the health interventions in detail, however, family caregivers were of the opinion that all possible medical acts were opportune and necessary, even when they appear to be particularly invasive interventions, such as defibrillation manoeuvres.