Vegetative state
| Persistent vegetative state | |
|---|---|
| Classification and external resources | |
| Specialty | Neurology |
| ICD-9-CM | 780.03 |
| Patient UK | Persistent vegetative state |
| MeSH | D018458 |
A persistent vegetative state (PVS) is a disorder of consciousness in which patients with severe brain damage are in a state of partial arousal rather than true awareness. After four weeks in a vegetative state (VS), the patient is classified as in a persistent vegetative state. This diagnosis is classified as a permanent vegetative state some months (3 in the US and 6 in the UK) after a non-traumatic brain injury or one year after a traumatic injury. Nowadays, more doctors and neuroscientists prefer to call the state of consciousness an unresponsive wakefulness syndrome, primarily because of ethical questions about whether a patient can be called "vegetative" or not.
There are several definitions that vary by technical versus laymen's usage. There are different legal implications in different countries.
A wakeful unconscious state that lasts longer than a few weeks is referred to as a persistent (or 'continuing') vegetative state.
Unlike brain death, permanent vegetative state (PVS) is recognized by statute law as death in very few legal systems. In the US, courts have required petitions before termination of life support that demonstrate that any recovery of cognitive functions above a vegetative state is assessed as impossible by authoritative medical opinion. In England and Wales the legal precedent for withdrawal of clinically assisted nutrition and hydration in cases of patients in a PVS was set in 1993 in the case of Tony Bland, who sustained catastrophic anoxic brain injury in the 1989 Hillsborough disaster. An application to the Court of Protection is still now required before nutrition and hydration can be withdrawn or withheld from PVS (or 'minimally conscious' - MCS) patients.
This legal has led to vocal advocates that those in PVS should be allowed to die. Others are equally determined that, if recovery is at all possible, care should continue. The existence of a small number of diagnosed PVS cases that have eventually resulted in improvement makes defining recovery as "impossible" particularly difficult in a legal sense. This legal and ethical issue raises questions about autonomy, quality of life, appropriate use of resources, the wishes of family members, and professional responsibilities.
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