Permanent vegetative state: the legal position

Medicine's diagnostic and therapeutic capacities raise increasingly complex ethical and legal issues for consideration. This is particularly so when the patient is in a permanent vegetative state. This article reviews the current legal position in the case of adults in permanent vegetative state (pVS), with particular attention to the devices used by courts in reaching decisions about whether or not to prolong assisted nutrition and hydration. The article further considers the impact of the Human Rights Act 1998, and argues that the current legal position is significantly, if not determinatively, based on clinical judgement, even where there is some doubt about whether or not the cases actually meet the terms of the Royal College of Physicians (RCP) diagnostic guidelines. In addition, the article asks whether or not the devices used by courts to permit withdrawing assisted nutrition and hydration from patients in pVS could be categorised as assisted death, and notes the (arguable) weakness of these devices as a basis for derogation from the sanctity of life principle.