Abstract
Persistent vegetative state (PVS) is a chronic neurological disorder of consciousness, in which patients appear to be awake, but show no behavioural evidence of awareness. It cannot be diagnosed with certainty and misdiagnosis is very frequent. Its management has become one of the most controversial and emotive issues in medical ethics and medical law over the past few decades. The results of recent neuroimaging studies along with well-documented reports of significant late recovery of some PVS patients have challenged the long-held view that restoration of function in the severely traumatic brain injury (TBI) patients is not possible. Some clinicians believe that PVS is a misused term with the potential consequences of withdrawal and withholding of care, and tendency towards less aggressive management. Further naming these patients as vegetative has been misinterpreted by many groups that the patient is no more a human but vegetable like. Recently there has been an attempt to replace PVS by new, more appropriate name "Unresponsive Wakefulness Syndrome" (UWS). As opposed to brain death, PVS is not recognized by statute as death in any legal system. The context within which end of life decisions are being made for these patients has led to outrage especially if decisions were made to terminate hydration and nutrition. We present a case of young boy who is in a PVS following TBI with the aim to review some of the contemporary issues regarding their management. DOI: http://dx.doi.org/10.3329/bjms.v13i3.19159 Bangladesh Journal of Medical Science Vol.13(3) 2014 p.358-365
Highlights
Persistent vegetative state (PVS) is a chronic neurological disorder of consciousness, in which patients appear to be awake, but show no behavioural evidence of awareness
Persistent vegetative state after traumatic brain injury function and consciousness. The results of these studies, along with well-documented reports of significant late recovery of some persistent vegetative state (PVS) patients, has challenged the long-held view that restoration of function in the severely TBI patients is not possible and that all forms of treatment are futile in these patients
We present a case of young boy who is in a PVS following TBI and attempt to review the specific ethical aspects of managing these patients
Summary
The management of PVS patients is an extremely difficult and challenging task for relatives, medical professionals and society in general. As medical technology advances at a rapid pace, the ability to sustain such patients will improve. Clinical research is needed to continue efforts at researching better ways to manage such patients, and explore novel treatment to facilitate emergence from VS. We need much more data before we make any assertive conclusions about the effect of pharmacological and non-pharmacological treatment in PVS patients. Under current prevailing conditions, when we are facing escalating health care costs in scarce resource communities, we must establish just mechanisms to deal with these patients and limit the use of expensive treatments of marginal benefit, so that that family can achieve an outcome which, painful, is compassionate. Ethical approval: Ethics Committee of International Islamic University Malaysia approved publication of this case report
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