A persistent vegetative state (PVS), also known as cortical death, is a condition of patients with severe brain damage in whom coma has progressed to a state of wakefulness without detectable awareness. The term was coined in 1972 by Scottish neurosurgeon Bryan Jennett and American neurologist Fred Plum to describe a syndrome that seemed to have been made possible by medicine's increased capacities to keep patients' bodies alive. [1] A persistent vegetative state is not the same as coma.
Patients in a persistent vegetative state are usually considered to be unconscious and unaware. They may experience sleep-wake cycles, or be in a state of chronic wakefulness. They may exhibit some behaviors that can be construed as arising from partial consciousness, such as grinding their teeth, swallowing, smiling, shedding tears, grunting, moaning, or screaming without any apparent external stimulus. They are unresponsive to external stimuli, except, possibly, pain stimuli. Few people have been reported to recover from PVS. Some authorities hold that PVS is, in fact, irreversible, and that the reportedly recovered patients were not suffering from true PVS.
As opposed to brain death, PVS is not recognized as death in any known legal system. This legal grey area has led to several court cases involving people in a PVS, those who believe that they should be allowed to die, and those who are equally determined that, if recovery is possible, care should continue. Well-known cases include Paul Brophy and Sunny von Bülow. The case of Terri Schiavo is often cited as an example of PVS, having been so diagnosed by multiple court-appointed physicians; a dispute of this diagnosis was a major issue in a lengthy and unsuccessful court challenge.
Reference
- Jennett B, Plum F. (1972). Persistent vegetative state after brain damage. A syndrome in search of a name. Lancet 1 (7753), 734–737. PMID 4111204.
- Multi-Society Task Force on PVS (1994). Medical aspects of the persistent vegetative state. N Engl J Med (330), 1499–508. PMID 7818633, PMID 8177248.
- Borthwick C (1996) The permanent vegetative state: ethical crux, medical fiction? Issues Law Med. 1996 Fall;12(2):167-85. Fulltext on author's website (Author questions the validity of most PVS diagnoses, and the validity of the basic nosology.)
- Andrews K, Murphy L, Munday R, Littlewood C. (1996). Misdiagnosis of the vegetative state: retrospective study in a rehabilitation unit. BMJ (313), 13–16. PMID 8664760, fulltext.
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