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Human Rights Act does not affect the law on PVS

BMJ 2000; 321 doi: https://doi.org/10.1136/bmj.321.7266.916 (Published 14 October 2000) Cite this as: BMJ 2000;321:916

Permanent vegetative state and persistent vegetative state are not interchangeable terms

Sir, I read with much interest the News Report by Clare Dyer on
doctor’s right to withdraw artificial hydration and nutrition in patients
in a permanent vegetative state [1]. However, in order to avoid any
misinterpretation by the medical community on this ethically very
important matter, I would like to correct the author when she states that
permanent vegetative state was previously referred to as persistent
vegetative state. The decision to withdraw artificial feeding only applies
to patients who are in a permanent vegetative state and not to patients
who are in a persistent vegetative state. It is very important to stress
the difference between both terms which are, unfortunately, abbreviated
identically as PVS by different authors [1, 2].

The vegetative state, a clinical condition of wakefulness without
awareness, can be partially or totally reversible or it may progress to a
persistent vegetative state or death [3]. “Persistent vegetative state” is
arbitrarily coined as a vegetative state present one month after the brain
damage but does not imply irreversibility [2]. “Permanent vegetative
state” implies the prediction that the patient will not recover. It was
introduced by the Multi-Society Task Force on Persistent Vegetative State
to denote irreversibility after three months following a nontraumatic
brain injury and 12 months after traumatic injury [2].

In line with the recommendations of the American Congress of
Rehabilitation Medicine [4], I personally prefer to avoid the use of the
terms "persistent" and "permanent" in favour of simply specifying the
length of time our patients spent in a vegetative state.

1. Dyer C. Human Rights Act does not affect the law on PVS. BMJ
2000;321:916.

2. The Multi-Society Task Force on PVS. Medical aspects of the persistent
vegetative state (1). N Engl J Med 1994;330:1499-508.

3. Wade DT, Johnston C. The permanent vegetative state: practical guidance
on diagnosis and management. BMJ 1999;319:841-4.

4. American Congress of Rehabilitation Medicine. Recommendations for use
of uniform nomenclature pertinent to patients with severe alterations of
consciousness. Arch Phys Med Rehabil 1995;76:205-209.

Dr Steven LAUREYS MD PhD

Cyclotron Research Centre - B30,
University of Liège - Sart Tilman,
4000 Liège - Belgium

E-mail: steven.laureys@ulg.ac.be

Dr Marie-Elisabeth FAYMONVILLE

Department of Anesthesiology and Intensive Care

Sart Tilman University Hospital - B35,
4000 Liège - Belgium

E-mail: mfaymonville@chu.ulg.ac.be

Dr Jacques BERRE

Department of Intensive Care

Erasme University Hospital,
Route de Lennik 108,
1070 Brussels - Belgium

E-mail: jberre@ulb.ac.be

Competing interests: No competing interests

17 October 2000
Steven Laureys
Cyclotron Research Centre B30 - University of Liège - Sart Tilman - 4000 Liège - Belgium
Cyclotron Research Centre B30 - University of Liège - Sart Tilman - 4000 Liège - Belgium