Euthanasia is illegal in the US but Assisted suicide or Physician aid in dying (PAD), is legal in the states of Washington, Oregon, Montana, and Vermont. While machinery and intubations can prolong life, they also can be legally removed to ensure death with dignity. Even feeding tubes can be removed legally. Often issues occur when the patient does not have a living will or advanced directives and the family members do not agree on what should be done. It is often difficult to see a loved one in the persistent unresponsive state. It is also difficult to make the decision that this loved one should be taken off machinery or tube feedings, thus causing their death. The Terri Schiavo case is an example of the difficulties families face.

Health care professionals should address spiritual needs of their patients. The issues related to Euthanasia is part of the many topics that patients at the end of life needs to discuss and have support to deal with the complexity of the process of dying.

These types of questions are difficult at best and often depend upon individual viewpoints. Without specifically engaging in the moral or ethical arguments regarding euthanasia options I might propose some alternate ways of thinking about the question posed. I first suggest that the most important viewpoint to consider is that of the person in the vegetative state. The question you pose has several underlying assumptions that should first be explored. It would be important to address how the individual involved might self-define a dignified death. You will find that an understanding what is a dignified death for one individual may not meet that of another. Important too is recognizing that your question presents an underlying assumption that euthanasia is a dignified death for all. A starting point for you may be to further explore the concept of dying with dignity.

From the more pragmatic side, I concur with previous commentary that life supports can generally be legally withdrawn and add that we have very good ways to maintain the comfort of individuals dying. Healthcare professionals skilled in palliative care generally have very good clinical and assessment skills to appraise for and act upon preserving comfort levels. The dignified death of those in PVS may be located in withdrawal of artificial life supports with active interventions to preserve the individual's comfort.

Death with dignity is ethical issue which needs to be addressed by ethics committee. It is often difficult for clinicians and family to step back and address global issue while being so focused on details of patient care. Limitations of care should be addressed on all patients as a routine. Euthanasia is not the issue here. Euthanasia has no role in patient care. Withdrawal of care or support is not euthanasia.

Individuals in PVS surely have dignity and no doubt to be respected for their views as a human being. Yet their PVS status is unable to allow us knowing their authentic views and choices before the issue of euthanasia is pondered on ...

What do you mean by "death with dignity"?

It is difficult to ascertain what is death with dignity as a lot depends on factors such as cultural beliefs such as 'karma' , religious beliefs and pre- illness patient's wishes. Even if the patient had expressed a desire to discontinue life support should they find themselves in a PVS, their views may have changed if and when the situation arises. At best it is the responsibility of health professionals and family to ensure care is provided in a dignified way.

"Death with dignity" is a specious phrase. In my opinion this question is answered by observers and the answer rests on faith. If the observers believe in an afterlife then the question of dignity is irrelavent as death, no matter the circumstances in which it occurs, is dignified.

Dignity, like caring is an abstract term that may have different meaning for each of us. Dignity may have cultural implications that may be difficult for the health care provider to understand. Perhaps defining dignity may provide a clearer answer to your question.

This is quite a loaded question. Euthanasia is illegal in Australia however provision of a dignified death for people in a PVS occurs every day around the world through several options. First if people have made an Advance Care Plan medical staff and the family will be very clear as to the individual's wishes with regards to PVS. If the individual believes that life is precious regardless of the circumstance than they will be cared for until they die of natural causes. If the person has stipulated in their Advance Care Plan that PVS would be an unacceptable way to live than the person will be placed on palliative care where interventions will be based on comfort cares and quality of life only. Death will not be hastened nor prolonged according to the person's wishes. People with PVS on palliation who have done an Advance Care Plan would include in that plan, where they would like to die and if they want spiritual leadership despite their PVS. I have seen people die very dignifed deaths despite PVS surrounded by people they love and in a manner that remained true to that persons spiritual and moral beliefs and values.

In Belgium, since 2002, euthanasia is legal. There are some conditions to fulfill but it's perfectly possible for adult patients with unsupportable sufferings. There is a Federal Commission to examine all euthanasias (1133 in 2011 - 1% of annual deaths in Belgium - see report in attachment). It is also possible for every citizen to fill a dedicated form to refuse some therapeutics in case of PSV ("anticipated declaration"). The most important thing is to respect the will of each patient.

Our Parliament is now discussing about the possibility to extend this right to people younger than 18 years. The last opinion poll shows that 75% of the population would agree with specific conditions.

Problem remains when the patient is in PSV without "anticipated declaration"...

In reading this question it is one that is being asked more and more. The answer must be complex as it would depend who was making the interpretation. As a professional nurse I am aware of the demands we make on ourselves and our colleagues during this type of care and would like to feel we offered all that can be achieved including and on-going dialogue with the person as we never know if they can hear? I am also to aware this can cause distress to some of the relatives/visitors. Therefore the only way you can comment on this situation is the think of it in relation to all the participants. I am only too aware the situation may not be correct having seen a person return form such a diagnosis and what she could tell us was illuminating.

Susan

@all researchers: thank you very much for your responses. This would be a great help for me.

@Dan Lecocq: I downloaded the pdf but would you mind if i ask you if you have that in english?

sustaining life by means of intubations and high technology with the knowledge that more than one organ is dead is like preventing one from dying with dignity, as this prolong pain and suffering. Respecting human dignity entails reduced suffering and allowing natural death to occur.

Is there family involvement? Had the patient discussed their EOL wishes prior to becoming PVS? All questions that can be asked of family, relatives and friends to assist the doctors in making the decision to allow death with dignity 

the family and friends form the important part of this dialogues, but the best interest of the patient is the only determining factor. they (relatives and friends) must all act in best interest of the patient. if family and friends request that the life be prolonged on high technology and give a blind eye to the pain and suffering of the patient, such a request is in their best interests. thus the patient 's dignity is being ignored.