PVS

Intense debate persists about the terminology, clinical diagnosis, and criteria for decision making for patients in vegetative states. The acronym PVS technically refers to persistent vegetative state, but as noted by our authors “persistent” vegetative state typically becomes “permanent” vegetative state after a period of time, and diagnosis of the state cannot be absolutely certain. Various court cases in the USA have established parameters for bases on which to consider forgoing life-sustaining treatment and who has the moral (or legal) standing to make such decisions, but it is not the case in the USA, as it is in some other countries, that all such decisions must undergo judicial review. Support for patients in PVS involves patients, their families and friends, the organizations providing the care, the organizations funding the care, and the individual care providers, and while some cases proceed with little disagreement, as in this case, there is considerable opportunity for disagreement and ethical quandary.

There has been a spate of literature discussing the “minimally conscious” state, a description of patients for whom the criteria of PVS are not met. The medical discussion is bedeviled by the difficulty of drawing a bright line in a continuum of conscious states, and the ethical discussion by the inevitable fact that an argument for treating (or withdrawing) at any point on that continuum can equally well justify the same course of action for the case next to it on that continuum – a conundrum sometimes called the “slippery slope.”