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Council on Scientific Affairs and Council on Ethical and Judicial Affairs

JAMA. 1990;263(3):426-430.

Abstract
Persons with overwhelming damage to the cerebral hemispheres commonly pass into a chronic state of unconsciousness (ie, loss of self-awareness) called the vegetative state. When such cognitive loss lasts for more than a few weeks, the condition has been termed a persistent vegetative state, because the body retains the functions necessary to sustain vegetative functions. Recovery from the vegetative state does occur, but many persons in persistent vegetative states live for months or years if provided with nutritional and other supportive measures. The withdrawal of life support from these persons with loss of higher brain function is a controversial issue, as highlighted by public debates and judicial decisions. This article provides criteria for the diagnosis of permanent unconsciousness and reviews the available data that support the reliability of these criteria. Significant legal decisions have been made with regard to withdrawal of life support to patients in persistent vegetative states, and the trends in this area are discussed.

(JAMA. 1990;263:426-430)

Author Affiliations
From the Council on Scientific Affairs and the Council on Ethical and Judicial Affairs, American Medical Association, Chicago, Ill.

Footnotes
This report was presented to the American Medical Association House of Delegates in June 1989 and was filed for information as a report of the Council on Scientific Affairs and the Council on Ethical and Judicial Affairs.

This report is not intended to be construed or to serve as a standard of medical care. Standards of medical care are determined on the basis of all of the facts and circumstances involved in an individual case and are subject to change as scientific knowledge and technology advance and patterns of practice evolve. This report reflects the views of scientific literature as of June 1989.

Reprint requests to Council on Scientific Affairs, American Medical Association, 535 N Dearborn St, Chicago, IL 60610 (William R. Hendee, PhD).

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