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The unresponsive wakefulness syndrome in the Netherlands: outcomes from a vicious circle .

van Erp, W.S.

4 november 2020


The primary goal of medicine has classically been to prolong life. Over the last century, chances of survival for the severest injuries and diseases have dramatically increased(1, 2). The notion that the yield of this progress was not exclusively positive started to emerge early in the 1950s. Having overcome the critical first hours to days after acute brain damage, incidentally patients remained in a state devoid of ‘evidence suggesting them to be in touch with their surroundings’(3). The general public in the Netherlands first learned about such outcomes in 1966, when the father of a young woman called Mia Versluis sought public attention. She had permanently lost consciousness due to hypoxemia during an elective surgical procedure(4).

In 1972, British neurosurgeon Bryan Jennett and American neurologist Fred Plum proposed the term ‘persistent vegetative state’, to describe a condition of autonomous vital functions and spontaneous eye opening without evidence of conscious awareness(5). It had previously been known as ‘coma vigil’ and ‘apallic syndrome’. In years to follow, ‘vegetative’ patients following acute, acquired brain injury increasingly became the subject of neuroscientific, clinical and public attention. These three perspectives crossed regularly, but were not as intertwined as might have been beneficial to the patients, families and health care professionals involved.