End of life care: Adult patients who lack capacity and are not expected to die within hours or days

1. 119. If a patient is in the end stage of a disease or condition, but you judge that their death is not expected within hours or days, you must provide clinically assisted nutrition or hydration if it would be of overall benefit to them, taking into account the patient’s beliefs and values, any previous request for nutrition or hydration by tube or drip and any other views they previously expressed about their care. The patient’s request must be given weight and, when the benefits, burdens and risks are finely balanced, will usually be the deciding factor.
2. 120. You must assess the patient’s nutrition and hydration needs separately. If you judge that the provision of clinically assisted nutrition or hydration would not be of overall benefit to the patient, you may conclude that the treatment should not be started at that time or should be withdrawn. You should explain your view to the patient, if appropriate, and those close to them, and respond to any questions or concerns they express.
3. 121. In these circumstances you must make sure that the patient’s interests have been thoroughly considered. This means you must take all reasonable steps to get a second opinion from a senior clinician (who might be from another discipline) who has experience of the patient’s condition but who is not already directly involved in the patient’s care. This opinion should be based on an examination of the patient by the clinician. In exceptional circumstances, if this is not possible for practical reasons, you must still get advice from a colleague, for example by telephone, having given them up-to-date information about the patient’s condition. You should also consider seeking legal advice.³⁵
4. 122. If you reach a consensus that clinically assisted nutrition or hydration would not be of overall benefit to the patient and the treatment is withdrawn or not started, you must make sure that the patient is kept comfortable and that any distressing symptoms are addressed. You must monitor the patient’s condition and be prepared to reassess the benefits, burdens and risks of providing clinically assisted nutrition or hydration in light of changes in their condition. If clinically assisted nutrition or hydration is started or reinstated after a later assessment, and you subsequently conclude that it would not be of overall benefit to continue with the treatment, you must seek a second opinion (or, if this is not possible, seek advice), following the advice in paragraph 121.