Permanent loss of awareness is crucial to diagnosis of PVS

New guidance on diagnosing and managing patients in the vegetative state were issued this week by the Royal College of Physicians, updating and clarifying guidelines issued in 1996 and correcting apparent inconsistencies in the earlier advice.

The college revised the guidance after the official solicitor, Laurence Oates, passed on a request from Dame Elizabeth Butler-Sloss, president of the High Court's family division, for clarification. Dame Elizabeth presides over cases where court approval is sought for the withdrawal of artificial nutrition and hydration.

Mr Oates told the BMJ there were a few passages in the Royal College of Physicians' 1996 …