The persistent vegetative state: a 'fate worse than death'

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Abstract
Patients who pass into prolonged coma and then into the 'vegetative state' (VS) or 'persistent vegetative state' (PVS),1 are medical enigmas. These terms are often used interchangeably, and are frequently considered to refer to an irrecoverable condition, synonymous with neocortical death. The case history of a patient diagnosed as vegetative and caught within the medical and legal systems is presented. The problems of diagnosis as well as the difficulties in management in such a patient are shown to have significant repercussions on the patient, the family and the community. Since every VS patient may cause enormous expenditure for life-time care, governments will be obliged to look at methods to reduce both the incidence and the severity of severe brain injury. Every effort must be made to prevent VSs from occurring. To resolve the problems of the research and management of prolonged coma and the VS it is proposed that (1) coma care units, (2) a coma register, (3) acute coma care review committees, and (4) chronic coma care review committees be established.

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