Cortical death - Treating disorders of consciousness

Treatment can't ensure recovery from a state of impaired consciousness, but measures can be taken to increase the chances of natural improvement.

This will usually involve:

providing nutritional support through a feeding tube
making sure the person is regularly moved so they don't develop pressure ulcers
gently exercising their joints to prevent them from becoming tight
keeping their skin clean
managing their bowel and bladder, such as using a tube known as a catheter to drain the bladder
keeping their teeth and mouth clean

Attempts will also be made to reduce the chances of infection, which can be dangerous for someone in a state of impaired consciousness.

Sensory stimulation

A treatment called sensory stimulation may help increase responsiveness in some people with impaired consciousness.

It involves stimulating some of the main senses – touch, hearing, vision and smell – for a short time each day. It's usually carried out by a trained specialist, but family members are often encouraged to be involved.

Some examples of sensory stimulation include:

visual – showing photos of friends and family, or a favourite film
hearing – talking or playing a favourite song
smell – putting flowers in the room or spraying a favourite perfume
touch – holding their hand or stroking their skin with different fabrics

It's not entirely clear how effective sensory stimulation is, but it's sometimes considered worthwhile.

Withdrawing nutritional support

If a person is in a state of impaired consciousness for a long time, usually at least 12 months, it may be recommended that nutritional support is withdrawn. This is because:

there is almost no chance of a recovery by this point
prolonging life would have no benefit to the individual concerned
prolonging treatment would offer only false hope and cause unnecessary emotional distress to the friends and family of the person concerned

The medical team will discuss the issue with family members and will give them time to consider all the implications.

If agreement is reached about withdrawing life support, the decision has to be referred to the courts in England, Wales and Northern Ireland before any further action can be taken. In Scotland, a court ruling is not required, but is often sought.

If the court agrees with the decision, nutritional support will be withdrawn and the person will die peacefully within a few days or weeks.