Editing Vegetative state (section)

=== 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>