In the 30 years since the vegetative state was defined and named there has been a gradual evolution of medical knowledge about its diagnosis, prognosis and pathology. However, there remains much that we do not yet know – in particular about the nature of consciousness and about how even partial recovery can occur after many months. The diagnosis and prognosis remain matters of probability rather than of certainty. This makes the condition no different from many others in medicine that require decisions to be made about management in order to provide compassionate care. The medical uncertainties about the vegetative state have recently been reviewed by an English neurologist (1) who emphasized also the persisting ethical uncertainties. Some of these derive from the unresolved clinical problems, but there is also the question of the equitable use of scarce medical resources when it comes to indefinite life support for permanently vegetative patients. This is particularly difficult to justify when there is such a broad consensus among doctors, ethicists and lawyers that prolonging survival in this condition brings no benefit to the patient.

Lawyers, also, are still wrestling with the problems that these patients pose for them. In the South African case, the judge observed that the law was but a translation into policies of society's fundamental values (p. 205); whether discontinuing treatment for a permanently vegetative patient was considered wrongful had to be judged by the legal convictions and boni mores of a society.