Abstract

PERSONS WHO ARE IN A MINIMALLY CONSCIOUS STATE DIFFER FROM those who are vegetative in that they have some awareness of themselves and others. Because of this awareness, their care should differ from the custodial care that is given to people in a persistent vegetative state. It should also include rehabilitative services that would help to increase their ability to function at their optimal level. This care also needs to include assistance in restructuring identity. Because persons in a minimally conscious state have a story, a narrative, that both precedes and follows their time in health care institutions, their families are best equipped to help them work on their identity issues. Many families are willing to accept this challenge if proper support systems have been put in place. The principle of subsidiarity suggests that this should be done. In addition, this approach would build on the relational components of these individuals and would eliminate the feelings of abandonment that most patients in a minimally conscious state and their families currently experience.