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A persistent vegetative state (or PVS) is a condition of patients with severe brain damage in whom coma has progressed to a state of "wakefulness without awareness". The term was introduced by two doctors in 1972 to describe a syndrome that seemed to have been made possible by medicine's increased capacities to keep patients' bodies alive. A persistent vegetative state is not the same as coma, the major distinction being that coma sufferers cannot breathe on their own.
Patients in a persistent vegetative state are usually considered to be unconscious and unaware, but exhibit sleep-wake cycles and some behaviors that can be construed as arising from partial consciousness, such as grinding their teeth, swallowing, smiling, shedding tears, grunting, moaning, or screaming without any apparent external stimulus. Their heads and eyes can track moving objects or turn towards a sound.
Few people ever recover from PVS, but in occasional cases, family members who visit the patient will detect evidence of awareness when doctors with limited patient contact will deny it. Eye tracking is often the earliest symptom of recovery.
As opposed to brain death, PVS is not recognized as death in any known legal system. This legal grey area has led to several court cases involving people in a PVS state, those who believe that they should be allowed to die, and those who are equally determined that, if recovery is possible, care should continue. Well-known cases include Terri Schiavo, Paul Brophy, and Sunny von Bülow.
Reference
- Andrews K, Murphy L, Munday R, Littlewood C. Misdiagnosis of the vegetative state: retrospective study in a rehabilitation unit. BMJ 1996;313:13-6. PMID 8664760 (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=8664760), fulltext (http://bmj.bmjjournals.com/cgi/content/full/313/7048/13).
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