Royal College of Physicians. Prolonged disorders of consciousness following sudden onset brain injury: national clinical guidelines (6 March 2020)

Summary

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 sudden onset brain injury, 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 the PDOC Guideline Development Group, which included representation of patients/users and a wide range of stakeholders and professionals involved in the management of patients with PDOC.

People in a vegetative or minimally conscious state present a complex array of medical, ethical and legal challenges.

Content

The guidelines offer updated guidance on the diagnosis, assessment, care and management of patients with PDOC. They support doctors, families and health service commissioners to ensure that everyone is aware of their legal and ethical responsibilities.

The guidelines cover:

• Definitions and terminology of PDOC.
• Techniques for assessment, diagnosis and review.
• Care pathways from acute to long-term management.
• The ethical and medico-legal framework for decision-making.
• Practical decision-making regarding starting or continuing life-sustaining treatments, including CANH, and management of end-of-life care for PDOC patients.
• Service organisation and commissioning.