Complete absence of behavioral evidence for self or environmental awareness

What is the vegetative state?

• There is preserved capacity for spontaneous or stimulus–induced arousal, evidenced by sleep–wake cycles i.e. patients are awake, but have no awareness. This means that the patients appear awake.
• They have normal heart beat and breathing, and do not require advanced life support to preserve life and cannot produce a purposeful, co–coordinated, voluntary response in a sustained manner, although they may have primitive reflexive responses to light, sound, touch or pain.
• They cannot understand, communicate, speak, or have emotions and unaware of self and environment and have no interaction with voluntarily control passing of urine or stools. They sleep and awaken. As the centers in the brain controlling the heart and breathing are intact, there is no threat to life, and patients can survive for many years with expert nursing care.
• The following behaviors may be seen in the vegetative state:
• Sleep–wake cycles with eyes closed, then opened. Patient breathes on her own; Spontaneous blinking and roving eye movements; Produce sounds but no words; Visual pursuit following an object with her eyes; Grimacing to pain; changing facial expression; Yawning; chewing jaw movements Swallowing of her own spit No purposeful limb movements; arching of back; reflex withdrawal from painful stimuli; brief movements of head or eyes toward sound or movement without apparent localization or fixation; startles with a loud sound.

Almost all of these features consistent with the diagnosis of permanent vegetative state were present during the medical examination of Aruna Shaunbag. Behavior suggestive of a minimally conscious not vegetative state observed during the examination.