Intended for healthcare professionals

Career Focus

Dealing with end of life decisions

BMJ 2004; 328 doi: (Published 01 May 2004) Cite this as: BMJ 2004;328:s178
  1. Chitra Pandilwar, locum senior house officer in medicine
  1. Walsgrave Hospital, Coventry

There's no simple formula for dealing with life and death decisions, but these practical tips might help you think more clearly:

  • The patient's interests should always come first

  • Remember that adults with capacity have the right to refuse or withdraw their consent to medical treatment. Their decision doesn't have to be reasonable or justifiable to anyone apart from themselves, even if the outcome is certain death

  • If a patient is not currently competent to make decisions, then look to advanced directives, statements, or wills for guidance

  • Advanced statements deserve thorough consideration and respect. Where valid and applicable they must be followed

  • Consult with a “proxy decision maker” (a person appointed by the patient to take decisions on his or her behalf)

  • Discuss the patient's wishes with the patient's family and friends

  • Talk with the patient's general practitioner

  • Make every attempt to discuss any “do not attempt resuscitation” decisions with the patient—and make sure any decisions are carefully and clearly recorded in their notes

  • Use the support of other professionals in the team

  • Doctors make end of life decisions in about half of all deaths. There are two main types of end of life decisions:

    1. Withholding and withdrawing life-prolonging treatment. Life must not be preserved at all costs—treatment must be more of a benefit than a burden. Decisions need to be clinically warranted. Most decisions taken by doctors fall into this category

    2. Giving medications actively to end life (euthanasia)—this is not legal in the United Kingdom

If in doubt always discuss the patient with senior colleagues or fellow consultants, and your medical defence organisation.

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