Module 1: Introduction
1.3 Defining terms
This course focuses on long term coma, usually more accurately known as ‘the vegetative state’.
The vegetative state is known in some countries as ‘unresponsive wakefulness syndrome’. In this course we stick to the term ‘vegetative’ even though some people dislike this label. We chose to use ‘vegetative’ because this is the clinical term used in the UK where we did our research and because, as you’ll discover later, some families have found the term useful.
Sometimes the media and the public confuse the vegetative state with other conditions so here is a quick activity to clarify the distinction.
Note down your answer to the following questions:
- What is the difference between the vegetative state and locked-in syndrome?
- What is the difference between the vegetative state and brain death
Now check your answers by clicking on each of the three tabs below.
What is the difference between the vegetative state, brain death or locked in syndrome?
Click on each of the tabs above for clinical information about these three completely different conditions.
Patients who are ‘LOCKED-IN’’ are conscious but paralysed, for example after a stroke. They can usually communicate by using movements of the eyes or eyelids. The person can have full mental capacity’: their memories, understanding, awareness of themselves and their environment and ability to make decisions may be fully intact. Some people regain movement after a period of being locked-in, others are locked-in permanently. The locked-in state is an entirely different condition from the vegetative state. (Now click on the next tab above).
A patient who is ‘BRAIN DEAD’ has irreversibly lost brainstem function which controls breathing and other reflexes. When someone is ‘brain dead’ they have no reflexes. They will never regain consciousness but can be maintained indefinitely in such a state by modern medical interventions e.g. the ventilator. In many jurisdictions such patients count as legally dead and ‘life-support’ (often called in this situation ‘somatic support’) is always withdrawn. However, some people do not accept this definition of death. A famous example of a disputed case is Jahi McMath. She was moved from California the the State of New Jersey which allowed for conscientious objection to brain death and meant she could be sustained indefinitely in her conditions (her funeral took place after 5 years of being sustained in that condition). Although sometimes confused with ‘vegetative’, brain death is a different state. For an article about the media representation of brain death see (Daoust and Racine 2014) . For further brain death resources see http://thaddeuspope.com/braindeath.html.
A patient in a VEGETATIVE state is completely unaware of themselves or their environment, quite unlike someone who is ‘locked in’. Vegetative patients are usually able to breathe on their own, and are not necessarily dependent on a ventilator. Some people regain full or partial consciousness after a short period of being vegetative (this is not uncommon in the first year, for example). Other people enter the ‘Permanent’ or ‘chronic’ vegetative state and they may remain in that condition for the rest of their live. (You’ll learn about something called ‘the minimally conscious state’ is a unit later on in the course).
Jean-Dominique Bauby was left paralysed after a stroke and only able to communicate with his left eye. He wrote/dictated the book: ‘The Diving Bell and the Butterfly’ which was later made into a film
What is the clinical terms for his condition?
- Brain dead
- Locked-in syndrome
Click here to check the clinical term for Jean-Dominique Bauby's condition
Another potential confusion is between a vegetative state and a medically induced coma. Are you clear about the difference and the potential relationship between the two?
Note down your answer to the following question:
- What is the difference between the vegetative state and a medically induced coma?
Now check your answer by clicking on the tabs below.
What is the difference between a ‘medically induced coma’ and the vegetative state?
Click on each of the tabs above for clinical information
A medically induced coma is when a patient is deliberately sedated into unconsciousness for some days or weeks. This may be done to try to prevent the threat of serious brain injury.
It is often impossible to tell whether or not the patient may have actually suffered brain injury until they are weaned off the drugs and doctors are able to check their level of consciousness without sedation. Some patients survive induced coma without any brain injury. Others may show signs of different levels of injury (eg being in a vegetative or minimally conscious state, or returning to full consciousness but with a range of neurological challenges). Recovery time and repeated skilled testing is needed to confirm outcomes for these patients.
A patient who is ‘ ‘VEGETATIVE’ has been unconscious for some time, and they are unconscious because of serious brain injury rather than because of any medical intervention or clinical complication suppressing their consciousness. They may remain in a vegetative state for weeks or months or even years . It may turn out to be a permanent state. The longer they remain deeply unconscious the less likely it becomes that they will ever regain full consciousness.
There are some other definitions you’ll be learning about later on in the course. For example you’ll learn (in Module 4) about the difference between the vegetative (completely unconscious) and minimally conscious (some intermittent low level consciousness). However, for now you have the crucial distinctions you need to know to understand the focus of this course. Now move on to the next unit.