Doctors to review coma guidelines

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The Independent Online
CLARE GARNER

New guidelines on the diagnosis and care of patients supposedly in an irreversible vegetative state are to be issued later this year, following the case of a man who woke up after seven years.

The existing rules, published in 1992 after the case of the "right to die" Hillsborough victim Tony Bland, state that at least a year must pass before any decision is reached on the patient's future. But following the latest example of a coma patient coming round, the British Medical Association will this week start updating its guidelines for the treatment of patients in a persistent vegetative state (PVS).

"We were due to review our guidelines but obviously this case highlights the need to do so more urgently," said a BMA spokesman. "It raises the issue of classification of persistent vegetative state and looks at the timescale. By the end of spring we hope to to have new guidelines."

The case of the former businessman who started communicating with staff at The Royal Hospital for Neuro-Disability in Putney, south-west London, after seven years of supposedly being in PVS, has highlighted the difficulties of diagnosis.

The patient arrived at the UK's only centre for treatment ients at the end of November, supposedly in a vegetative state. Within weeks of assessment, he was defined as "not in PVS".

A hospital spokeswoman said: "The situation at the moment is that the man is profoundly disabled. That is, he will be sitting in a wheelchair and he will be using very limited means to communicate."

Professor Bryan Jennett, Emeritus Professor of Neurosurgery at Glasgow University, who diagnosed the man as being in PVS last year, said such cases depended wholly on clinical observation. "The case highlights the caveat which has always existed in the guidelines; that one must try to be as sure as possible that the person is in PVS and not `locked-in' syndrome [a state which allows limited communication]."

The hospital has conducted a study into similar cases of misdiagnosis "so we can have confidence in looking at the options".

Leading article, page 14

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