Persistent vegetative state in children: terminology, aetiology, prognosis and ethical issues

The vegetative state comprises a group of clinical features of profound brain damage, which appear to demonstrate that the patient is awake but not aware of internal or external environments. The term was introduced to replace others used in the past, such as prolonged coma or coma vigile. Children are in a special position because at certain ages there should be consideration not only of their severe disability or handicap but also of their potential to become conscious. Terminology and definitions that are now quite well delineated are described. The boundaries of the vegetative state are noted and its diagnosis and prognosis are discussed in detail. Finally, ethical considerations are discussed, with regard to the different stances taken in different countries. In the Appendix the results of a short survey of members of the Paediatric section of UEMS (European Union of Medical Specialists)/EAP are summarized on the various attitudes and ethical considerations on persistent vegetative state in children.