Patients in the persistent vegetative state: a response to Dr Andrews.

Conclusion I have asked questions to which I have no answers. The factors influencing them are rarely clinical but depend much more on the attitude of society to the care of disabled people and to social, legal, emotional, political, cultural, religious, and economic forces. Irrespective of whether it is legal to withhold food from patients in the persistent vegetative state, these problems will continue to face physicians responsible for the long term care of such severely disabled people. Patients and their families may now have to be reassured that the withholding of food will not be automatic. Before such actions are considered it is essential that a full rehabilitation programme should be offered to patients in the early stages of the persistent vegetative state to give them the optimal chance of recovery. And we should be absolutely certain that our diagnosis is correct.