First published in The Lawyers Weekly January 24, 2003, Vol. 22, No. 35
Conscious, Comatose and Brain Dead are no longer enough.
8 years ago Persistent Vegetative State was defined by international consensus and 5 years ago Minimally Responsive State was replaced by the more accurate term Minimally Conscious State.
2002 saw Minimally Conscious State (MCS) defined and established in medical terminology.
For Personal Injury lawyers who do not specialise in catastrophic injury, the new terms Persistent Vegetative State and Minimally Conscious State may be a source of confusion.
However, the litigator who is thoroughly versed in the strengths and weaknesses of the research data and the changing concepts will be better placed to maximise the client’s Quantum of Damages.
Brain death means the permanent and complete absence of all brain functions.
Life can be maintained temporarily only with total life-support systems.
The remaining 3 conditions may be transient phases of recovery to full consciousness, or they may be permanent.
In coma there is deep unconsciousness lasting at least an hour, and arousal is not possible.
At least some vital functions of the brainstem persist, and life can be sustained with varying degrees of life-support systems.
Persistent Vegetative State
The persistent vegetative state differs from brain death and coma in that there are periods of eyes-open wakefulness, even though there is no consciousness.
This condition apparently arises from disproportionate damage to the thalamus in the brainstem.
Minimally Conscious State
In the minimally conscious state, patients show some awareness by purposive verbal or nonverbal communication in response to verbal request1.
The Aspen Work Group defines minimally conscious state as "a condition of severely altered consciousness in which minimal, but definite, behavioral evidence of self or environmental awareness is demonstrated."
Minimally Conscious State criteria - at least one of
1) Gives yes or no responses verbally or with gestures
2) Verbalizes intelligibly
3) Demonstrates other purposeful behaviour, including nonreflexive movements or affective [emotive] gestures that occur in direct relationship to relevant environmental stimuli.