Caring for Patients at the End of

Life
 Goals of End-of-Life Care

Patients must be offered dignity and privacy:

The usual rules of confidentiality apply.

➢ Patients should maintain control over as many

aspects of their care as possible, including by
advance planning if they wish.
➢ Health professionals should be sensitive to
patients' cultural and religious backgrounds.
➢ Care provided to dying patients includes
helping people close to them to come to terms
with the situation.
Goals of End of Life Care
➢ It is important to recognise when death is
approaching and to help people prepare for it.
➢ Compassion and sensitivity are particularly
important but honest communication is also
essential, while recognising that people's
desire for information can vary at different
stages of their illness.
➢ Effective communication within the health
team is vital so that mixed messages are
avoided.
Withholding Treatment, Nutrition, Hydration
➢ Difficult decisions to withhold or withdraw life-
prolonging treatment arise if treatment can no
longer provide sustained benefit to the patient.
➢ Reasons for not providing life-prolonging
treatment must be clearly communicated to
individuals who have capacity, or those close
to people who lack capacity.
➢ Efforts should be made to communicate with
people who appear to lack capacity.
Withholding Treatment, Nutrition, Hydration
➢ Advance care planning may indicate whether
treatment should be withheld or withdrawn.
➢ Treatment cannot be provided if patients have
made a valid refusal.
➢ Decisions for incapacitated patients are made
on the basis of their best interests or what
would benefit them.
➢ Oral nutrition and hydration should be
maintained as long as the patient is willing and
able to tolerate it; they cannot be forced on
patients who resist or refuse.
 Supporting an End of Life Patient
➢ Dying patients should have opportunities to
discuss matters such as where they want to
die.
➢ Giving patients the opportunity to plan aspects
of their care can have a positive psychological
effect.

[Many organisations, defined by their country of origin] provide a

nationally accepted framework for care in the last hours or days of
life.
Supporting an End of Life Patient
➢ Patients who have made an advance decision
to refuse some forms of active treatment can
override their advance decision as long as
they retain the mental capacity to do so.
➢ When patients with capacity approach the
stage where the aim shifts from curative to
supportive care, decisions about the benefits
or otherwise of further active treatment need to
be discussed with them.
 End of Life Decisions
Once it is recognized that the patient’s conditions is incurable,
palliative care offers relief from pain and distressing symptoms.
It also provides support for the patient's family.

➢ Any decision to withhold or withdraw life-prolonging treatment

and why should be documented in the patient's notes.
➢ Patients with capacity should be involved in decision making
about future treatment.
➢ Prior to withdrawing or withholding treatment, nutrition and
hydration, a senior clinician should talk to the patient.
 Euthanasia
Access to medically
assisted dying:

Respecting the Ensuring that vulnerable

autonomy of people who people are not pressured
want to end their lives to end their lives

➢ Societies have deeply-held moral beliefs about

❖ The value of life
❖ The qualities that make it valuable
❖ The scope and limits of individual autonomy
❖ The balancing of benefit for one patient with
the possibility of disadvantaging another
Medical Ethics Today
The BMA's Handbook of Ethics and Law

Third Edition