Persistent Vegetative State

Persistent Vegetative State/Permanent Vegetative State

Almost all medical ethicists discussing post-coma survival have been guilty of pernicious oversimplification of the medical background to their ideas. This oversimplification emerges clearly from any close reading of work on this topic.

I have examined different aspects of this issue in articles for a number of journals in this area.
 

1) PERSISTENT VEGETATIVE STATE; A SYNDROME IN SEARCH OF A NAME, OR A JUDGEMENT IN SEARCH OF A SYNDROME?

ABSTRACT
It is now over twenty years since Jennett and Plum in 1972 coined the name "persistent vegetative state" to describe a state that is "neither unconscious<ness> nor coma in the usual sense of these terms... <but rather> wakefulness without awareness".1 It is a term that has been widely used since, and the mantraps and spring guns that were built into the definition at the outset are still dangerous. Definitions decided on at the outset have channelled the debate ever since, and are still influential. It is important to re-examine the first steps in this area to see why that course was adopted then and why it is still directing us now.

This paper is reprinted with thanks to the Monash Bioethics Review, where it first appeared (1995, April, 14, 2, 20-26)

2) THE PROOF OF THE VEGETABLE; A COMMENTARY ON ETHICAL FUTILITY

ABSTRACT
Patients with ‘persistent vegetative state’ (PVS) are often cited in discussions of ethicists as examples of human beings who are unconscious and do not experience life, and a number of theoretical and practical recommendations have been made on that basis. This article examines the evidence and the theoretical rationale for the belief that people with PVS are unconscious and finds them wanting. This conclusion is related to the discipline of ethics.

This paper is reprinted with thanks to the Journal of Medical Ethics , where it first appeared (1995, 21 (4), 205-8).

3) THE PERMANENT VEGETATIVE STATE; ETHICAL CRUX, MEDICAL FICTION?

ABSTRACT
In 1994 a Multi-Society Task Force made up of representatives of the American Academy of Neurology, the Child Neurology Society, the American Neurological Association, the American Association of Neurological Surgeons, and the American Academy of Pediatrics produced a Consensus Statement on the Medical Aspects of the Persistent Vegetative State (PVS). This Statement presents a picture of the degree of diagnostic certainty achievable in this area that is in many respects misleading. Its attempt to propose a condition called Permanent Vegetative State, which would be based on a high degree of medical certainty either that there is no further hope for recovery of consciousness or that, if consciousness were recovered, the patient would be left severely disabled, confuses two different issues.

This paper is reprinted with thanks to Issues in Law and Medicine, where it first appeared.
Cite as Borthwick C The permanent vegetative state: ethical crux, medical fiction? Issues Law Med. 1996 Fall;12(2):167-85.

4) THE PERMANENT VEGETATIVE STATE;
Usefulness and limits of a prognostic definition

Borthwick CJ, Crossley R., Permanent vegetative state: usefulness and limits of a prognostic definition. NeuroRehabilitation. 2004;19(4):381-9.

ABSTRACT

Jennett and Plum’s 1972 naming of post-coma unresponsiveness as “persistent vegetative state (PVS)” characterised the condition as essentially irrecoverable and insentient. The evidence for these propositions was always weak, and they have been largely disproved by more recent research. Nonetheless, the definition and the attitudes it embodies remain generally accepted, resting as they do on a firm foundation of medical attitudes to disability and a public willingness to evade uncomfortable facts. The first step in altering our approach to people with this form of communication impairment must be to rectify our understanding of the terminology.

This paper is reprinted with thanks to NeuroRehabilitation, where it first appeared.

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