Introduction

We can now not only postpone death but we can prolong death. Moribund people may be kept alive for hours or days, until support is withdrawn or death inevitably occurs. One situation, brainstem death, is now regarded in law as death, even though the heart is beating.

Patients in the permanent vegetative state are as dead as those who are brainstem dead. They have no awareness—no experience of life or social interaction—and they will eventually die without regaining any autonomy. The differences are that (A) this situation has not (yet) been legally defined as death, (B) the diagnosis is not so categorically and easily determined and (C) the process of death may extend for many years.

The management of patients with prolonged disorders of consciousness, including the permanent vegetative state, is challenging because of the uncertainties about diagnosis (eg, can we know that someone is unaware?) and prognosis (eg, can we be certain that recovery will not occur?). Clinical staff and managers often take the easy option—just continue treatment—because it is much less challenging. But is that correct?

New guidance on prolonged disorders of consciousness from …