ABSTRACT
The plight of the American woman Terri Schiavo provides the contextual background for this discussion which looks at the particular challenge to the law posed by patients in a persistent vegetative state (PVS). This paper begins with an analysis of this condition, aiming to indicate that its characteristics are such that the issue of decision-making in relation to patients in a PVS is one of such ethical sensitivity that the law in this area should respond carefully and thoroughly to these concerns. The discussion then focuses upon the legal approach to the management of such patients as it has developed within existing US case law, looking to the rationale behind the existing legal framework. Following from this, the paper takes a comparative approach to the issue, exploring the English and Australian judicial attitudes to decision making with respect to the adult incompetent patient, having particular regard to relevant developments in human rights jurisprudence. The discussion ultimately concludes with a comparison between the concepts of substituted judgment and best interests, and concludes that the former concept, whilst evidentially problematic, is not, like the latter, fundamentally flawed.
