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.

Guidance on clinically-assisted nutrition and hydration (CANH) was published by the BMA and the RCP in December 2018.

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.

Guidance on clinically-assisted nutrition and hydration

New interim guidance on clinically-assisted nutrition and hydration (CANH) from the Royal College of Physicians (RCP) and the British Medical Association (BMA), and endorsed by the General Medical Council (GMC), was published in December 2018 in response to a number of legal developments. You can access the guidance on the BMA website.

The guidance aims to ensure the law is followed correctly and to give practical advice to health professionals about how to make these difficult decisions, based on what is in the best interests of the individual patient.

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.