The medical term vegetative is seen as potentially pejorative if misunderstood by families or carers as being synonymous with vegetable.
• The diagnosis of vegetative state depends on clinical observation of the presence or absence of behaviour that might indicate a functioning mind (Jennett & Plum 1972). As self-awareness cannot be measured, but only identified through an absence of purposeful responses to environmental stimuli, it has been suggested that the term vegetative be replaced by a clinical term descriptive of continuing unresponsiveness.
• Prediction of outcome may influence patient management (Murray et al 1993). Where the term persistent vegetative state is used inappropriately or taken to indicate permanence of an unresponsive state in an individual, it may lead to withholding of opportunities for rehabilitation and restriction or limitation of access to other treatments (Andrews 1996; Zasler 1996).
• The abbreviation PVS may be interpreted to mean either persistent or permanent vegetative state. Criteria for use of the qualifier permanent vary in overseas guidelines and some guidelines have suggested that there may be more than one type of vegetative state (Multi-Society Task Force 1994; Andrews 1996; Royal College of Physicians of London 1996). It has been suggested that use of the qualifiers persistent and permanent be avoided and that, instead, the duration of the vegetative state be specified (American Congress of Rehabilitation Medicine 1995).
• Medical use of the term permanent vegetative state is based on the high statistical clinical probability of the vegetative state continuing indefinitely. It has been suggested that non-medical understanding of permanent is absolute, rather than statistical. Reports of late emergence or possible initial misdiagnosis (Tresch et al 1991; Childs et al 1993; Multi-Society Task Force 1994; Andrews et al 1996) have heightened this concern.