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National clinical guidelines on the care of people in a vegetative or minimally conscious state, following severe brain injury
These long-awaited guidelines will be a major contribution to clinical and ethical standards of care for this group of patients, not only in the UK but internationally. For England and Wales, they provide much needed clarity on legal decision-making.
The guidelines were developed by a panel of experts in the field, who have organised complicated and wide-ranging information into six coherent sections:
1 Defining criteria and terminology
2 Assessment, diagnosis and monitoring
3 Acute to longer-term management
4 Ethical and medico-legal issues
5 End-of-life issues
6 Service organisation and commissioning
Each section is followed by a set of clear recommendations.
Concise, clear information
People in a vegetative or minimally conscious state present a complex array of medical, ethical and legal challenges, and the guidelines address them all, incorporating the most recent clinical and legal developments.
The withdrawal of life-sustaining treatments, and end-of-life care for patients, are contentious and emotive subjects, but the guidelines present the facts clearly and without bias. They lay out for clinicians, other healthcare professionals, service providers and commissioners, what constitutes best practice within the existing legal framework. In addition, the legal profession and families of patients will find the guidelines an invaluable source of concise and up-to-date information.
Help for families and friends
The role of patients’ families, and their need for support and information, is emphasised throughout. There are also two free leaflets on how medical decisions are made on behalf of people who, by definition, cannot make these decisions themselves – an area that can be very confusing for patients’ families.
The free online annexes provide a range of guidance and tools designed to enhance the practical care and assessment of these patients, including tools and information for their families.
Guidance for all healthcare professionals involved
These are high-quality, comprehensive guidelines written by professionals dedicated to improving every aspect of care for these patients, and should be read not only by specialists in this field but by all who care for these complex patients.