Ethical Issues in Diagnosis and Management of Patients in the Permanent Vegetative State The permanent vegetative state is diagnosed when a patient is unaware of himself or herself and his or her envi
Ethical Issues in Diagnosis and Management of Patients in the Permanent Vegetative State The permanent vegetative state is diagnosed when a patient is unaware of himself or herself and his or her envi
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Ethical Issues in Diagnosis and Management of Patients in the Permanent Vegetative State
The permanent vegetative state is diagnosed when a patient is unaware of himself or herself and his or her environment and there is no prospect of any change in this state by any means. The clinical characteristics and diagnosis of the condition have been established (box).1–6 Nevertheless, the clinical diagnosis is not always easy because there is a spectrum from the vegetative state to full awareness. The border between these two states is referred to as the low awareness state.1 No absolute definition exists for low awareness state. Generally, however, the patient behaves in a way that implies that at times he or she may be able to extract meaning from a stimulus and may be able to respond in a goal directed way. Usually the state is intermittent, with only vegetative responses being present at other times. Rarely, it may be possible to establish some form of rudimentary communication. We do not know if patients have any day-to-day memory or appreciation of their situation or whether they can experience somatic or emotional pain or pleasure.