PERSISTENT VEGETATIVE STATE - CLINICAL AND ETHICAL ISSUES

Coma, vegetative state, lock-in syndrome and akinetic mutism are defin ed. Vegetative state is a state with no evidence of awareness of self or environment and showing cycles of sleep and wakefulness. PVS is an operational definition including time as a variable. PVS is a vegetati ve state that has endured or continued for at least one month. PVS can be diagnosed with a reasonable amount of medical certainty; however, the diagnosis of PVS must be kept separate from the outcome. The patie nt outcome can be predicted based on etiology and age. Using outcome p robabilities and etiology as criteria, patients can be subdivided in 5 groups and reasonable management guidelines can be suggested. Three l evels of care can be provided to PVS patients: high technology, suppor tive and compassionate care. Pragmatic options for the various subgrou ps of patients are suggested. Management decisions will remain difficu lt for both the family and the health- care team. The role of the phys ician in these difficult cases is to share the decision-making with th e family.