Report is unnecessarily negative

BMJ 1995;310:1137 (29 April)

Letters

Report is unnecessarily negative

EDITOR,--Robin S Howard and David H Miller's editorial on thepersistent vegetative state¹ is timely because several workingparties are debating this condition, including the Royal Collegeof Physicians; the European Union's biomedical and health researchprogramme (BIOMED I) at the Centre of Medical Law and Ethicsat King's College, London; and an international working partyand conference on management of the condition held at the RoyalCollege of Physicians in March. The editorial reviews the positionof the Multi-Society Task Force.² ³ Considerable concern hasbeen expressed, particularly among consultants in rehabilitation,that the task force's report is unnecessarily negative.

The international working party was set up because of concernthat insufficient attention was being given to the treatment,especially the rehabilitation, of patients in a persistent vegetativestate. It will debate the concern about the terminology used;the classification of patients into various levels of persistentvegetative state and states of low awareness; the need for moresensitive measurement scales; the effectiveness of treatmentprogrammes; and the relevance of rehabilitation for medical,legal, and social policy. Concern must be expressed at the assumptionmade by many people that severe disability is not worth achieving.This has implications for the treatment not only of people withsevere brain damage but also of those with other chronicallydisabling disorders.

The persistent vegetative state is so rare that it is difficult,even in specialist units such as the Persistent Vegetative StateRehabilitation Unit in Putney, to build up sufficient researchdata to provide answers to many of the questions required tomake reasonable clinical, legal, and social decisions on behalfof such unfortunate patients and their families.

Director of medical and research services Royal Hospital andHome, Putney, London SW15 3SW

Keith Andrews