Rethinking sexual health clinics

which a patient can reasonably be thought to have a continued interest."5The level of treament will depend on the result of clinical assessment by the physician and discussion with the patient's family or other decision makers.The place of high technology treatments (mechanical ventilation, dialysis, cardiopulmonary resuscitation) and routine drugs (such as antibiotics) or other treatments such as supplementary oxygen can be determined only in the context of the individual case.2 3The BMA has recommended that "if it is apparent at the end of a twelve month period of insentience due to persistent vegetative state that the patient's condition is irreversible doctors will consider whether it is in the patient's best interest to continue with treatment to prolong life."7The findings of the American Multi-Society Task Force challenge these recommendations by suggesting that a persistent vegetative state is almost always permanent at three months if the cause was a non-traumatic cerebral insult.Although the evidence is strong, experience (particularly in the subgroups) is not yet still adequate to recommend a change in the British recommendations-but these are currently under review by a working party established by the royal colleges.Both the medical and the legal authorities have advised that in some circumstances when the patient's condition is irreversible withdrawal of life sustaining treatment, including tube feeding, may be legitimate and ethically acceptable.12Such a decision requires independent evaluation of the diagnosis and prognosis, the likely benefits or burdens of treatment, the patient's views if known, and the views of the people close to the patient.In Britain the decision to withdraw artificial nutrition from a patient in a persistent vegetative state requires consultation with the courts.