Abstract

The persistent vegetative state (PVS) was described in the Lancet exactly 30 years ago by Bryan Jennett, a neurosurgeon, and the neurologist Fred Plum (Jennett & Plum 1972). Jennett has recently reviewed the subject (Jennett 2002). Sometimes described as a condition of wakefulness without awareness, it can follow a range of severe insults to the brain. Often misdiagnosed, frequently misunderstood, the syndrome provides a useful shorthand for a diverse but distinctive set of clinical phenomena. Although it has withstood the scrutiny of ethicists and lawyers, it assumes a concept of awareness that may not stand the test of time. In this article I will sketch its key features and end by asking how confident we can really be that a patient in the PVS is wakeful, but conscious of nothing.

Many of us will remember our first encounter with a patient in the vegetative state (VS), as the condition is