Ventilation or dignified death for patients with high tetraplegia.

The case histories of the 37 patients of the Mersey Regional Spinal Injuries Centre who were artificially ventilated between 1968 and 1984 were reviewed. The patients and caring relatives were interviewed separately to determine their views. Of 21 patients who were still alive, 18 said that they would wish to be temporarily ventilated again if the need arose, two were undecided, and one said that she would wish to be allowed to die. Sixteen caring relatives said that they were glad that the decision to ventilate had been taken. Those who were not glad were all young mothers. The outcome from any combination of factors that existed before injury could not be predicted except that most patients over age 59 fared badly. Patients with spinal cord damage should be artificially ventilated if required, provided that this can be carried out well and that total emotional, educational, and physical support can be provided and maintained. Whether or not scarce resources should be deployed in this manner requires discussion.