Certain Considerations of the Persistant Vegetative State

Lee, In Soo

Abstract

Patients with overwhelming demage to the cerebral hemispheres commonly pass into a chronic state of unconsciounsness(ie, loss of self awareness) called the vegetative state. When such cognitive loss lasts for more then a few weeks, the condition has been termed a persistent vegetative state. The auther reviewed "Position of the American Academy of Neurology on certain aspects of the care and management of the persistent vegetative state patient" adopted by the Executive Board, American Academy of Neurology, April 21, 1988 and "Current Opinions of the Council on Ethical and Judicial Affairs of the American Medical Association" - 1989. In the U.S.A. they insist :If the patient is competent to act in his own befalf and did not previously indicate his preferences, the family or other surrogate decision maker, in concert with the physician, must act in the best interest of the patient" and "Even if death is not imminent but a patient is beyond doubt permanently unconscious, and there are adequate safeguards to confirm the accuracy of the diagnosis, it is not unethical to discontinue all means of life-prolonging medical treatment." In Korea :brain death" has not been referred to the death of the individual yet socially and legally. The neurosurgeons in our country must consider about how seriously to treat vegetative patients and brain death patients who are unlikly to improve, in the concerns of bio-medical ethice. On the other hand, they recognize that their capacity to achieve a diagnosis and highly probable prognosis represents the indispensable basis for any decision. This article provides criteria for the diagnosis of persistent vegetative state and reviews the available data of my 19 patients. Lastly in our country any considerations or discussions have not yet been made with regard to withdrawal of life support to patients in persistent vegetative states according to the national emotion and morality.