We aim to improve the medical care and understanding of disorders of consciousness following an acute insult such as coma, vegetative state, minimally conscious state or locked-in syndrome. Coma Science Group Cyclotron Research Center & Neurology Dept University of Liège
Although DJ's condition is in many respects grim, I am not persuaded that treatment would be futile or overly burdensome, or that there is no prospect of recovery. (a) In DJ's case, the treatments in question cannot be said to be futile, based upon the evidence of their effect so far. (b) Nor can they be said to be futile in the sense that they could only return DJ to a quality of life that is not worth living. (c) Although the burdens of treatment are very great indeed, they have to be weighed against the benefits of a continued existence. (d) Nor can it be said that there is no prospect of recovery: recovery does not mean a return to full health, but the resumption of a quality of life that DJ would regard as worthwhile. The references, noted above, to a cure or a return to the former pleasures of life set the standard unduly high.
Respect for patient autonomy and the right of individuals to make their own healthcare decisions where possible lies at the core of the recent Mental Capacity Act 2005. The Act gives statutory authority to “Advance Decisions” (ADs) – enabling people to communicate their healthcare decisions in advance of losing the capacity to do so (e.g. due to coma or dementia). This is increasingly important when new medical technologies mean it is now possible keep people alive for years or for decades in permanent vegetative or minimally conscious states (i.e. with no – or virtually no – awareness of themselves or their environment).