END OF Life Decision Making

Meet the patient

Mr K is a 78-year-old man with metastatic lung cancer, admitted with a pathological rib fracture and worsening breathlessness. He has been told his cancer is incurable but has not discussed what he would want if he became too unwell to speak for himself. His wife asks you, quietly, whether everything is being done. The nurse asks whether he is for resuscitation. ^[2]

The question the examiner is testing is not whether you know the dose of morphine. It is whether you can identify a patient approaching the end of life, open the goals-of-care conversation early, document an advance care plan, and — when distress is refractory — apply proportionate palliative sedation with multidisciplinary and family consensus. The conversation you have not had is the one that will be held in a crisis. ^[2]

References10ShowHide

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3. [3]Olsen ML, Swetz KM, Mueller PS Ethical decision making with end-of-life care: palliative sedation and withholding or withdrawing life-sustaining treatments Mayo Clinic proceedings, 2010.PMID 20805544
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7. [7]Arantzamendi M, Belar A, Payne S et al. Clinical Aspects of Palliative Sedation in Prospective Studies. A Systematic Review Journal of pain and symptom management, 2021.PMID 32961218
8. [8]Rousseau PC Palliative sedation The American journal of hospice & palliative care, 2002.PMID 12269773
9. [9]Holloway RG, Arnold RM, Creutzfeldt CJ et al. Palliative and end-of-life care in stroke: a statement for healthcare professionals from the American Heart Association/American Stroke Association Stroke, 2014.PMID 24676781
10. [10]Tremblay A, Pelet S, Belzile É et al. Strategies to improve end-of-life decision-making and palliative care following hip fracture in frail older adults: a scoping review Age and ageing, 2024.PMID 38970548