The persistent vegetative state in children: Report of the child neurology society ethics committee

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Abstract
Increasing concern about children in a persistent vegetative state (PVS) prompted a survey of members of the Child Neurology Society regarding aspects of the diagnosis and management of this disorder. Major findings of those responding to this survey (26% response rate) were as follows: (1) 93% believed that a diagnosis of PVS can be made in children, but only 16% belived that this applied to infants younger than 2 months and 70% in the 2-month to 2-year group; (2) a period of 3 to 6 months was belived to be the minimum observation period required before a diagnosis of PVS could be made; (3) 86% believed that the age of the patient would affect the duration of time needed to make the diagnosis of PVS; (4) 78% thought a diagnosis of PVS could be made in children with severe congenital brain malformations; (5) 75% believed that neurodiagnostic studies would be of value and supportive of the clinical diagnosis of PVS; (6) members' opinions as to the average life expectancy (in years) for the following age groups after the patients were considered vegetative were: newborn to 2 months, 4,1;2 months to 2 years, 5.5; 2 to 7 years, 7.3; and more than 7 years, 7.4; (7) 20% believed that infants and children in a PVS experience pain and suffering; and (8) 75% “never” withhold fluid and nutrition from infants and children in a PVS and 28% “always” give medication for pain and suffering. The data suggest that child neurologists believe PVS can be diagnosed in children after 2 years of age, but that in younger children a more cautious approach is indicate. The findings suggest reasonable agreement concerning many of these issues, and it may be possible at this time to develop a position statement on the medical aspects of PVS in children.