The vegetative state: Promoting greater clarity and improved treatment

Abstract

The condition commonly referred to as the persistent vegetative state (PVS) or vegetative state (VS) generates tremendous confusion among health care professionals. Muddled and nihilistic views of very severe brain injury have hampered efforts to improve the diagnosis and treatment of patients thought to be in the VS. Significant obstacles to diagnostic clarity arise from multiple sources including imprecise terminology and conflation of the concepts of “behaviour” and “awareness”. Failure to employ effective, uniform protocols of assessment and rehabilitation contributes to inadequate treatment of these extremely vulnerable patients. Despite diagnostic and prognostic difficulties, courts across the globe have accepted medical opinion as persuasive evidence for life-support withdrawal. A new outlook on severe brain injury is needed, with greater clarity and standardisation of assessment and care. Best practices in assessment and rehabilitation must be incorporated along with new developments in cognitive neuroscience and neuroimaging. Such a rehabilitative view will encourage intellectual curiosity towards improved quality of care for patients with severe brain injury. Attaining high levels of accuracy depends upon reaching a clearer understanding of the nature of human consciousness itself, of the condition, and of the patient's potential for full or partial recovery.