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End of life care guidance: Case study 2

This case study explores issues arising from decisions about clinically assisted nutrition and hydration (CANH).

Please note

The case studies are fictional and for illustration purposes only.

They do not represent GMC guidance or policy in themselves, nor are they intended to replace Treatment and care towards the end of life: good practice in decision making (2010) or any other GMC guidance.

All paragraph numbers highlighted in this case study refer to the GMC's guidance Treatment and care towards the end of life: good practice in decision making (2010). You can download the guidance here (469 kb, pdf) for reference.

Part 1

Mr Singh is 82 and the head of a large Sikh family. He had a haemorrhagic stroke two months ago which left him with a reduced consciousness level and unable to communicate in any meaningful way. He did, however, retain the ability to swallow soft food.

His family, including his daughters and granddaughters, have cared for him at home and have been feeding him by mouth for the duration of his illness.

During the last week his consciousness level has declined a little more and he is now having difficulties swallowing. Dr Dawson, Mr Singh’s GP for the past six years, suspects that he has had further cerebral bleeding.

She is concerned that Mr Singh may choke on food or aspirate, causing a chest infection, and discusses her concerns with Mr Singh’s daughters. They want to continue caring for their father at home including feeding him by mouth if this is at all possible.

It is an important part of their culture and the care they provide, and they feel strongly that it is what Mr Singh would want.

What factors should Dr Dawson be taking into account to decide what to do next?

  • Approaching decisions when patients lack capacity
    (Paragraphs 15-16)

  • Making sound clinical judgements
    (Paragraphs 24-27, including seeking advice or a second opinion)

  • Assessing whether Mr Singh is receiving nutrition and hydration to meet his needs by oral feeding, including assessing any underlying causes for his swallowing difficulties
    (Paragraphs 109-111).


Download the guidance

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