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Media coverage of the persistent vegetative state and end-of-life decision-making

From the Neuroethics Research Unit (E.R., M.S., M.K.), Institut de recherches cliniques de Montréal; Department of Medicine (E.R.), University of Montreal; Department of Neurology and Neurosurgery (E.R.), Biomedical Ethics Unit (ER), McGill University, Canada; and Center for Biomedical Ethics (R.A., J.I.) and Department of Pediatrics (J.I.), Stanford University, CA's current affiliation: National Core for Neuroethics, University of British Columbia, Canada.

Address correspondence and reprint requests to Dr. Eric Racine, Director, Neuroethics Research Unit, IRCM, 110 Pine Avenue West, Montreal, Quebec, Canada H2W 1R7 Eric.racine{at}ircm.qc.ca

Background: Conflicting perspectives about the diagnosis and prognosis of the persistent vegetative state (PVS) as well as end-of-life (EOL) decision-making were disseminated in the Terri Schiavo case. This study examined print media coverage of these features of the case.

Methods: We retrieved print media coverage of the Schiavo case from the LexisNexis Academic database and used content analysis to examine headlines and text of articles describing Schiavo’s neurologic condition, behavioral repertoire, prognosis, and withdrawal of life support. The accuracy of claims about PVS was assessed.

Results: Our search yielded 1,141 relevant articles published (1990–2005) in the four most prolific American newspapers for this case. The most frequent headline themes featured legal (31%), EOL (25%), and political (22%) aspects of the case. Of the articles analyzed, 21% reported that Schiavo "might improve" and 7% that she "might recover." Statements explicitly denying the PVS diagnosis were found in 6% of articles. Explanations of PVS and other chronic disorders of consciousness were rare (1%). Most frequently cited descriptions of behaviors were that the patient responds (10%), reacts (9%), is incapacitated (6%), smiles (5%), and laughs (5%). Withdrawal of life support was described as murder in 9% of articles.

Conclusions: Media coverage included refutations of the persistent vegetative state (PVS) diagnosis, attributed behaviors inconsistent with PVS, and used charged language to describe end of life decision-making. Strategies are needed to achieve better internal agreement within the professional community and effective communication with patient communities, families, the media, and stakeholders.

Abbreviations: CDC = chronic disorders of consciousness; EOL = end-of-life; PVS = persistent vegetative state.

Editorial, page 964

e-Pub ahead of print on August 6, 2008, at www.neurology.org.

Supported by NIH/National Institute of Neurological Disorders and Stroke RO1 #NS045831-04 (J.I.), the Institut de recherches cliniques de Montréal (E.R.), the Social Sciences and Humanities Research Council of Canada (E.R.), and The Greenwall Foundation (J.I.).

Disclosure: The authors report no disclosures.

Received December 10, 2007. Accepted in final form May 2, 2008.

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