Duhaime's Law Dictionary


Persistent Vegetative State Definition:

No consciousness (comatose) and no possibility of recovery.

Related Terms: Death, Life, Permanent Unconscious Condition

Also known as a permanent vegetative state or permanent unconscious condition.

In Cruzon v Missouri Department of Health, Justice Rehnquist of the Supreme Court of the United States wrote:

"(A) persistent vegetative state (is) generally, a condition in which a person exhibits motor reflexes but evinces no indications of significant cognitive function."

In Cruzan v Harmon (same case but lower level court), Justice Robertson of the Supreme Court of Missouri described the catastrophic condition of Ms Nancy Beth Cruzan:

"Her respiration and circulation are not artificially maintained and are within the normal limits of a thirty-year-old female; (2) she is oblivious to her environment except for reflexive responses to sound and perhaps painful stimuli; (3) she suffered anoxia of the brain resulting in a massive enlargement of the ventricles filling with cerebrospinal fluid in the area where the brain has degenerated and [her] cerebral cortical atrophy is irreversible, permanent, progressive and ongoing; (4) her highest cognitive brain function is exhibited by her grimacing perhaps in recognition of ordinarily painful stimuli, indicating the experience of pain and apparent response to sound; (5) she is a spastic quadriplegic; (6) her four extremities are contracted with irreversible muscular and tendon damage to all extremities; (7) she has no cognitive or reflexive ability to swallow food or water to maintain her daily essential needs and . . . she will never recover her ability to swallow sufficient [sic] to satisfy her needs. In sum, Nancy is diagnosed as in a persistent vegetative state. She is not dead. She is not terminally ill. Medical experts testified that she could live another thirty years."

Persistent vegetative stateIn Re Jobes, Justice Girabaldi, of the Supreme Court of New Jersey, noted the words given at trial by Dr. Fred Plum, the creator of the term persistent vegetative state and a renowned expert on the subject, as follows on the related phrase vegetative state:

"Vegetative state describes a body which is functioning entirely in terms of its internal controls. It maintains temperature. It maintains heart beat and pulmonary ventilation. It maintains digestive activity. It maintains reflex activity of muscles and nerves for low level conditioned responses. But there is no behavioral evidence of either self-awareness or awareness of the surroundings in a learned manner."

But the Court also repeated the alternate definition provided by another expert (Dr. Ropper) as follows:

"The persistent vegetative state (is) one in which the patient is in or has sleep/wake cycles, is totally incapable of responding and is totally unaware of environment or self.... Primitive reflex responses to external stimuli would exclude a patient from the persistent vegetative state."

In Re Eichner, Justice Mollen of the Appellate Division of the Supreme Court of the State of New York proposed:

"The patient in a permanent vegetative coma has no hope of recovery and merely lies, trapped in a technological limbo, awaiting the inevitable. As a matter of established fact, such a patient has no health and, in the true sense, no life, for the State to protect."

In a hospital setting, a diagnosis of persistent vegetative state is often presented as a rationale or precursor to the cessation of life-sustaining procedures such as feeding tubes and respirators. In Barber v Superior Court, two doctors approved the removal of life-support from a patient correctly diagnosed as being in a persistent vegetative state. The doctors faced murder charges but the Court of Appeals of California rejected the proposal:

"A persistent vegetative state was described as that state in which the patient would have no contact with the environment but parts of the brain would continue to live....

"(A) murder prosecution is a poor way to design an ethical and moral code for doctors who are faced with decisions concerning the use of costly and extraordinary "life support" equipment....

"(P)etitioners did not kill the deceased since their conduct was not the proximate cause of death....

"As a predicate to our analysis of whether the petitioners' conduct amounted to an "unlawful killing," we conclude that the cessation of "heroic" life support measures is not an affirmative act but rather a withdrawal or omission of further treatment....

"A physician has no duty to continue treatment, once it has proved to be ineffective. Although there may be a duty to provide life-sustaining machinery in the immediate aftermath of a cardio-respiratory arrest, there is no duty to continue its use once it has become futile in the opinion of qualified medical personnel...."

In relevant judicial if not controversial statements, Justice Gloss of the House of Lords in England commented about treatment of a person in a persistent vegetative state in Airedale NHS Trust v. Bland, in words borrowed from Justice Schreiber in The Matter of Claire Conroy:

“When cherished values of human dignity and personal privacy, which belong to every person living or dying, are sufficiently transgressed by what is being done to the individual, we should be ready to say enough.

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