Table 2

Key features of the proposed fast-track application for withdrawal of CANH

Preconditions
1The patient is confirmed as being in a permanent vegetative state from which recovery of awareness is highly improbable
2There is no dispute that withdrawal of CANH is in the patient's best interests, taking into account their likely wishes, values and beliefs, so far as these are known
3Appropriate plans are in place for management of end-of-life care according to best practice, including backup plans for specialist support
Diagnosis
4There has been an adequate time frame for improvement—at least 6 months post-non-traumatic brain injury, or 12 months post-traumatic brain injury
5The patient has undergone an adequate period of assessment by appropriately trained and experienced PDOC assessors in a designated specialised PDOC unit (or by a specialist PDOC outreach service)
6Assessment has been conducted according to the RCP guidelines using two or more of the approved structured assessment tools:

  • The Wessex Head Injury Matrix administered serially over time, at least two to three times per week over 4 weeks

  • The Coma Arousal Scale-Revised at least 10 times over 4 weeks

  • The Sensory Modality Assessment and Rehabilitation Technique

Confirmation
7The above must be confirmed by two independent physicians who meet the requirements for experience and training in PDOC, as set out in the RCP PDOC guidelines
8Their assessment confirms that the conditions above have met the standards of best practice as laid out in RCP PDOC guidelines including:

  1. the conditions for diagnosis of a permanent vegetative state

  2. procedures for conducting and documenting best interests decision-making meetings

  3. plans for end-of-life care

  • CANH, clinically assisted nutrition and hydration; PDOC, prolonged disorders of consciousness; RCP, Royal College of Physicians.