Editing Vegetative state (section)

== Definition ==
There are several definitions that vary by technical versus layman's usage. There are different legal implications in different countries.

=== Medical definition ===
Per the definition of the British [[Royal College of Physicians]] of London, "a wakeful unconscious state that lasts longer than a few weeks is referred to as a persistent (or 'continuing') vegetative state".<ref name="rcplondon.ac.uk">{{cite web |work = Royal College of Physicians |date = 2013 |title = Prolonged Disorders of Consciousness: National Clinical Guidelines |url = https://www.rcplondon.ac.uk/resources/prolonged-disorders-consciousness-national-clinical-guidelines }}</ref>

=== Vegetative state ===
The vegetative state is a chronic or long-term condition. This condition differs from a [[coma]]: a coma is a state that lacks both awareness and wakefulness. Patients in a vegetative state may have awoken from a coma, but still have not regained awareness. In the vegetative state patients can open their eyelids occasionally and demonstrate sleep-wake cycles, but completely lack cognitive function. The vegetative state is also called a "coma vigil". The chances of regaining awareness diminish considerably as the time spent in the vegetative state increases.<ref>{{cite journal |title = Medical aspects of the persistent vegetative state (1) |journal = The New England Journal of Medicine |volume = 330 |issue = 21 |pages = 1499–508 |date = May 1994 |pmid = 7818633 |doi = 10.1056/NEJM199405263302107 |author1 = Multi-Society Task Force on PVS |doi-access = free }}</ref>

=== Persistent vegetative state ===
Persistent vegetative state is the standard usage (except in the UK) for a medical diagnosis, made after numerous neurological and other tests, that due to extensive and irreversible brain damage, a patient is highly unlikely ever to achieve [[Consciousness|higher functions]] above a vegetative state. This diagnosis does not mean that a doctor has diagnosed improvement as impossible, but does open the possibility, in the US, for a judicial request to end [[life support]].<ref name="Cranford_2004"/> Informal guidelines hold that this diagnosis can be made after four weeks in a vegetative state. US caselaw has shown that successful petitions for termination have been made after a diagnosis of a persistent vegetative state, although in some cases, such as that of [[Terri Schiavo]], such rulings have generated widespread controversy.

In the UK, the term is discouraged in favor of two more precisely defined terms that have been strongly recommended by the [[Royal College of Physicians|Royal College of Physicians (RCP)]]. These guidelines recommend using a ''continuous vegetative state'' for patients in a vegetative state for more than four weeks. A medical determination of a ''permanent vegetative state'' can be made if, after exhaustive testing and a customary 12 months of observation,<ref name="ncbi.nlm.nih.gov">{{cite journal |vauthors = Wade DT, Johnston C |title = The permanent vegetative state: practical guidance on diagnosis and management |journal = BMJ |volume = 319 |issue = 7213 |pages = 841–44 |date = September 1999 |pmid = 10496834 |pmc = 1116668 |doi = 10.1136/bmj.319.7213.841 }}</ref> a medical diagnosis is made that it is ''impossible'' by any informed medical expectations that the mental condition will ever improve.<ref name="rcp">{{cite book |title=Guidance on diagnosis and management: Report of a working party of the Royal College of Physicians |publisher=[[Royal College of Physicians]]: London |year=1996}}</ref> Hence, a "continuous vegetative state" in the UK may remain the diagnosis in cases that would be called "persistent" in the US or elsewhere.

While the actual testing criteria for a diagnosis of "permanent" in the UK are quite similar to the criteria for a diagnosis of "persistent" in the US, the semantic difference imparts in the UK a legal presumption that is commonly used in court applications for ending life support.<ref name="ncbi.nlm.nih.gov"/> The UK diagnosis is generally only made after 12 months of observing a static vegetative state. A diagnosis of a persistent vegetative state in the US usually still requires a petitioner to prove in court that recovery is impossible by informed medical opinion, while in the UK the "permanent" diagnosis already gives the petitioner this presumption and may make the legal process less time-consuming.<ref name="Cranford_2004"/>

In common usage, the "permanent" and "persistent" definitions are sometimes conflated and used interchangeably. However, the acronym "PVS" is intended to define a "persistent vegetative state", without necessarily the connotations of permanence,{{citation needed|date=November 2019}} and is used as such throughout this article. [[Bryan Jennett]], who originally coined the term "persistent vegetative state", has now recommended using the UK division between continuous and permanent in his book ''The Vegetative State'', arguing that "the 'persistent' component of this term ... may seem to suggest irreversibility".<ref name="Jennett"/>

The Australian [[National Health and Medical Research Council]] has suggested "post coma unresponsiveness" as an alternative term for "vegetative state" in general.<ref>{{cite book |title=Post-coma unresponsiveness (Vegetative State): a clinical framework for diagnosis |publisher=National Health and Medical Research Council (NHMRC): Canberra |year=2003 |url=http://www.health.gov.au/nhmrc/publications/synopses/hpr23syn.htm |url-status=dead |archive-url=https://web.archive.org/web/20060820035510/http://www7.health.gov.au/nhmrc/publications/synopses/hpr23syn.htm |archive-date=2006-08-20 }}</ref>

=== Lack of legal clarity ===
Unlike [[brain death]], permanent vegetative state (PVS) is recognized by ''[[statute law]]'' as [[death]] in only a very few legal systems. In the US, courts have required petitions before termination of life support that demonstrate that any recovery of cognitive functions above a vegetative state is assessed as impossible by authoritative medical opinion.<ref>{{cite journal |vauthors = Jennett B |title = Should cases of permanent vegetative state still go to court?. Britain should follow other countries and keep the courts for cases of dispute |journal = BMJ |volume = 319 |issue = 7213 |pages = 796–97 |date = September 1999 |pmid = 10496803 |pmc = 1116645 |doi = 10.1136/bmj.319.7213.796 }}</ref> In England, Wales and Scotland, the legal precedent for withdrawal of clinically assisted nutrition and hydration in cases of patients in a PVS was set in 1993 in the case of [[Tony Bland]], who sustained catastrophic anoxic brain injury in the [[Hillsborough disaster|1989 Hillsborough disaster]].<ref name="rcplondon.ac.uk"/> An application to the Court of Protection is no longer required before nutrition and hydration can be withdrawn or withheld from PVS (or "minimally conscious", MCS) patients.<ref>Royal College of Physicians 2013 [https://www.rcplondon.ac.uk/resources/prolonged-disorders-consciousness-national-clinical-guidelines Prolonged Disorders of Consciousness: National Clinical Guidelines]</ref>

This legal [[wikt:grey area|grey area]] has led to vocal advocates that those in PVS should be [[Euthanasia|allowed to die]]. Others are equally determined that, if recovery is at all possible, care should continue. The existence of a small number of diagnosed PVS cases that have eventually resulted in improvement makes defining recovery as "impossible" particularly difficult in a legal sense.<ref name="Cranford_2004">{{cite journal |vauthors = Cranford R |title = Diagnosing the permanent vegetative state |journal = The Virtual Mentor |volume = 6 |issue = 8 |pages = |date = August 2004 |pmid = 23260786 |doi = 10.1001/virtualmentor.2004.6.8.cprl1-0408 |doi-access = free }}</ref> This legal and ethical issue raises questions about autonomy, quality of life, appropriate use of resources, the wishes of family members, and professional responsibilities.