Professor Lynne Turner-Stokes
Brief Outline: Professor Lynne Turner-Stokes explains the conditions under which a patient can be determined to be in a ‘permanent’ vegetative state. She emphasises the need for skilled and repeat assessments.
Background: Lynne Turner-Stokes is a Consultant in rehabilitation medicine and Herbert Dunhill Medicine Professor of Rehabilitation, King’s College London. She chaired the Royal College of Physicians' working party on prolonged disorders of consciousness.
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Professor Lynne Turner-Stokes describes the move to specialist rehab settings for initial evaluations. She underlines the need for repeated re-assessment over the months or years that follow.
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So this is within the first year of the event?
So this is for the initial assessment and diagnosis, yes, which would definitely be, in the most cases nowadays, within that first year. What we obviously expect, according to the Guidelines now, is that patients will carry on being assessed at regular intervals. Those actual intervals may vary depending on what you’re expecting but roughly approximately six-monthly in the first stages and potentially annually thereafter. And so what you’re doing is you’re reviewing them, working with whoever’s looking after them, be they in a specialist nursing home, or in a home environment occasionally. So you’re working with family members and the care staff to identify whether there’s any change in the level of responsiveness.
Lynne describes the timescale and conditions for when a patient might be described as ‘permanently’ vegetative and reflects on what ‘permanent’ means.
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Is there a point at which, at least for some patients, you have felt in your own history, able to say: “This person will not regain consciousness, ever. Categorically.
It’s almost impossible to be categoric about anything in medicine – there’s always a certain level of uncertainty. But yes, in somebody for example who you’ve been observing over a prolonged period of time who is showing absolutely no signs of change at all and who’s remained in a vegetative state for many months or sometimes even years, I think one can be as certain as it’s possible to be in medicine that they’re not likely to recover. And therefore we need to think about decisions about whether continuing life-sustaining treatments is actually in their best interests.