The Eluana Englaro Case: Cause of death after the withdrawal of artificial nutrition and hydration in a subject in a permanent vegetative state and with quadriplegia

Abstract A 38-year-old woman, who had been in a permanent vegetative state with quadriplegia for 17 years following a motor vehicle accident, died 87 h after the judicially authorised suspension of artificial nutrition and hydration. Medico-legal investigations, requested by the Judicial Authorities...

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Bibliographic Details
Published in:Forensic science international 2013-09, Vol.231 (1), p.e24-e29
Main Authors: Moreschi, Carlo, Da Broi, Ugo, Rodriguez, Daniele, Froldi, Rino, Porzionato, Andrea, Macchi, Veronica, De Caro, Raffaele
Format: Article
Language:English
Subjects:
Accidents
Adult
Anuria - etiology
Body Temperature
Bradycardia - etiology
Brain - pathology
Coma
Death
Disturbances
Diuresis
End of life
Female
Fever
Fever - etiology
Fluid Therapy
Forensic Pathology
Forensic science
Forensic sciences
Heart Arrest - etiology
Humans
Hydration
Hypotension - etiology
Italy
Life support systems
Mucus - secretion
Myocardium - pathology
Nursing
Nursing care
Nutrition
Nutritional Support
Oliguria - etiology
Ostomy
Pathology
Patients
Permanent vegetative state
Persistent Vegetative State
Quadriplegia
Respiratory System - pathology
Sialorrhea - etiology
Sweating
Ventilation
Withdrawal of artificial hydration
Withdrawal of artificial nutrition
Withholding Treatment - legislation & jurisprudence
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Summary:Abstract A 38-year-old woman, who had been in a permanent vegetative state with quadriplegia for 17 years following a motor vehicle accident, died 87 h after the judicially authorised suspension of artificial nutrition and hydration. Medico-legal investigations, requested by the Judicial Authorities and focusing on the evaluation of clinical and necroscopic data, aimed to explain the cause of death, to exclude any lethal cause other than one deriving from the withdrawal of artificial nutrition and hydration and to verify the level of perceived discomfort and the correctness in the application of the supportive protocol during the end of life phase. The inability of quadriplegic patients to compensate critical hyperthermic and haemodynamic disturbances induced by dehydration was considered to be the cause of a rapid demise after the withdrawal of artificial sustenance.
ISSN:0379-0738
1872-6283
DOI:10.1016/j.forsciint.2013.05.021