Measuring health outcomes

The authors emphasise the importance of getting the diagnosis right, and few would argue with them.But it is interesting to note that all 17 patients who were found to be conscious were severely disabled; all were severely paralysed and anarthric, most were either blind or severely visually impaired, some were substantially cognitively impaired, and all were presumably dependent on feeding tubes.Reasonable people may differ in their views of the quality of life of these conscious individuals, but I would speculate that most people would find this condition far more horrifying than the vegetative state itself, and some might think it an even stronger reason for stopping treatment than complete unconsciousness.But whether being in the vegetative state is viewed as preferable to being just outside it, and whatever your views on withdrawal of tube feeding in such patients, careful examination of every patient is essential to determine their consciousness and ability to suffer.It would be dreadful indeed to stop treatmnent in patients who were thought to be unconscious but who could in fact experience thirst and hunger when treatment, including artificial nutrition and hydration, was stopped.Equally important is the need to maximise quality of life for those who are capable of communicating.Some may even be able to contribute to decisions about their medical treatment.