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8.1 - How to Manage the Process of Withholding or Withdrawing Treatment with the Multidisciplinary Team

from Section 8 - End-of-Life Care

Published online by Cambridge University Press:  27 July 2023

By
Margaret Presswood
Edited by
Ned Gilbert-Kawai ,
Debashish Dutta  and
Carl Waldmann
Ned Gilbert-Kawai
Affiliation:
The Royal Liverpool Hospital
Debashish Dutta
Affiliation:
Princess Alexandra Hospital NHS Trust, Harlow
Carl Waldmann
Affiliation:
Royal Berkshire Hospital, Reading
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Summary

Key Learning Points

  1. 1. The presumption in favour of prolonging life is not absolute.

  2. 2. Skilful communication with the patient and those close to them is needed to establish which treatments are of ongoing benefit.

  3. 3. Treatments can be withheld/withdrawn when refused by a patient with capacity or when deemed not to be in the best interests of a patient who lacks capacity.

  4. 4. Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions need to be communicated to patients and those close to them, unless this will cause physical or psychological harm.

  5. 5. Devise an individualised end-of-life care plan before life-sustaining treatments are withdrawn.

Keywords

palliationcommunicationcapacitymultidisciplinary team
Type
Chapter
Information
Intensive Care Medicine
The Essential Guide
 , pp. 671 - 673
Publisher: Cambridge University Press
Print publication year: 2021

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References

References and Further Reading

British Medical Association. Withholding or Withdrawing Life-Prolonging Medical Treatment, 3rd edn. London: Blackwell Publishing; 2007.Google Scholar
British Medical Association. Clinically-assisted nutrition and hydration (CANH) and adults who lack the capacity to consent. London: British Medical Association; 2018.Google Scholar
British Medical Association, Resuscitation Council UK, Royal College of Nursing. 2016. Decisions relating to cardiopulmonary resuscitation, 3rd edn, 1st revision. www.resus.org.uk/sites/default/files/2020-05/20160123%20Decisions%20Relating%20to%20CPR%20-%202016.pdfGoogle Scholar
General Medical Council. Treatment and care towards the end of life: good practice in decision making. London: General Medical Council; 2010.Google Scholar
Royal College of Physicians. 2020. Prolonged disorders of consciousness following sudden onset brain injury: national clinical guidelines. www.rcplondon.ac.uk/guidelines-policy/prolonged-disorders-consciousness-following-sudden-onset-brain-injury-national-clinical-guidelinesGoogle Scholar
Royal College of Physicians, British Society of Gastroenterology. Oral feeding difficulties and dilemmas: a guide to practical care, particularly towards the end of life. London: Royal College of Physicians; 2010.Google Scholar
Samanta, J. Tracey and respect for autonomy: will the promise be delivered? Med Law Rev 2015;23:467–76.CrossRefGoogle ScholarPubMed

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