[Vegetative states: a syndrome in search of a new name]

1. To critically analyze the concept of 'vegetative' state and a number of reasons that seem to justify the abandonment of this term. 2. To propose a new conceptual approach to the syndrome and, based on this approach, a new terminology.

The concept of 'vegetative' state became popular in the medical literature, in the context of a 'neocorticalist' theory of consciousness. Its clear-cut simplicity and the prestige of its proponents contributed to this acceptance. However, this concept seems to be neurologically and philosophically inappropriate. In addition, in recent years a number of studies have shown that these states are frequently misdiagnosed, due mainly to their inherent complexity. Thus, the need for a new name for this syndrome has become increasingly evident. A conceptualization of the brain global functioning leads to a redefinition of these states. The 'syndrome of brain dismetafunction' is conceptually defined. This term does not have a pejorative connotation. It respects the inherent uncertainty associated to the subjective dimension of consciousness as well as to the prognosis of these states. It promotes an integrative approach to problems related to the diagnosis, treatment, and rehabilitation of these patients.

It seems pertinent to propose the abandonment of the term 'vegetative' both as conceptually equivocal and as a term that may become a self-fulfilling prophecy. Moreover, a no less important reason to abandon this qualifier is the possibility of a more coherent conceptualization of this syndrome. As a consequence, this approach leads to a new terminology.