Prolonged disorders of consciousness: national clinical guidelines

The Prolonged disorders of consciousness national clinical guidelines are a major contribution to clinical and ethical standards of care for people with prolonged disorders of consciousness (PDOC) – including vegetative (VS) and minimally conscious states (MCS) – following severe brain injury, not only in the UK but internationally. For England and Wales, they provide much-needed clarity on legal decision-making.

Interim guidance on clinically assisted nutrition and hydration has been published in December 2017.

The Prolonged disorders of consciousness 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.

Concise, clear information

The guidelines lay out for clinicians, other healthcare professionals, service providers and commissioners what constitutes best practice within the existing legal framework. They address some highly emotive and topical issues, such as:

  • where patients are cared for
  • the appropriate use of life-sustaining treatments
  • management at the end of life.

People in a vegetative or minimally conscious state present a complex array of medical, ethical and legal challenges. Further systematic longitudinal data collection is urgently required in this area and the group has recommended the development of a national register and dataset to facilitate this. This recommendation is strongly endorsed by the RCP’s Council.

You can buy a print copy of the Prolonged disorders of consciousness guidelines from our online shop, or download a free PDF below.

Interim guidance on clinically assisted nutrition and hydration

New interim guidance from the Royal College of Physicians (RCP), British Medical Association (BMA) and General Medical Council (GMC) on clinically assisted nutrition and hydration (CANH) has been published in December 2017 in response to legal developments and outlines what we consider to be good clinical and professional practice in this area.

These decisions are clinically, legally and ethically challenging for clinicians. We are currently working with the BMA and the GMC to issue updated and in-depth guidance on good clinical and professional practice for making decisions about CANH which we are aiming to publish in May 2018.

This document is published to provide interim guidance for doctors and other clinical professionals pending publication of this new guidance.

Help for families and friends

By definition, VS and MCS patients are unable to make decisions regarding their own care and treatment. The role of patients’ families, and their need for support and information, is emphasised throughout.

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.