End of life care: Contents


About this guidance  
     How this guidance applies to you  


Principles 7-13
     Equalities and human rights 7-9
     Presumption in favour of prolonging life 10
     Presumption of capacity 11
     Maximising capacity to make decisions 12
     Overall benefit 13
Decision-making models 14-16
     Patients who have capacity to decide 14
     Adults who lack capacity to decide 15-16
Working with the principles and decision-making models 17-89
     Role of relatives, partners and others close to the patient 17-21
     Working in teams and across service boundaries 22-23
     Making sound clinical judgements 24-27
     Explaining the clinical issues 28-30
     Addressing uncertainty 31-32
     Emotional difficulties in end of life decision making 33-36
     Resource constraints 37-39
     Assessing the overall benefit of treatment options 40-46
             Weighing the benefits, burdens and risks 40-43
             Avoiding bias 44-46
     Resolving disagreements 47-49
     Advance care planning 50-62
             The benefits 50-51
             What to discuss 52-55
             When patients do not want to know 56-58
             When others want information to be withheld from the patient 59
             Formalising a patient's wishes 60
             Recording and sharing the advance care plan 61-62
     Acting on advance requests for treatment 63-66
     Acting on advance refusals of treatment 67
             When advance refusals are binding 68
             Non-binding advance refusals 69
             Assessing the validity of advance refusals 70
             Assessing the applicability of advance refusals 71
             Doubt or disagreement about the status of advance refusals 72-74
     Recording and communicating decisions 75-77
     Reviewing decisions 78
     Conscientious objections 79-80
     Organ donation 81-82
     Care after death 83
            The wishes and needs of the bereaved 84
            Certification, post-mortems and referral to the coroner or procurator fiscal 85-87
     Training and audit 88-89
Neonates, children and young people 90-91
     Considering the benefits, burdens and risks of treatment 92-96
     Making the decision 97-98
     Children and young people who have capacity 99-103
     Children and young people who lack capacity 104-105
     Neonates and infants 106
     Parents' concerns and anxieties 107
     Resolving disagreements 108
Meeting patients' nutrition and hydration needs 109-111
Clinically assisted nutrition and hydration 112-115
     Patients who have capacity 116-117
     Adult patients who lack capacity 118
     Adult patients who lack capacity and are not expected to die within hours or days 119-122
     Adult patients who lack capacity and are expected to die within hours or days 123-125
     Patients in a persistent vegetative state (PVS) or similar condition 126
     Conscientious objection 127
Cardiopulmonary resuscitation (CPR) 128
     When to consider making a Do Not Attempt CPR (DNACPR) decision 129-131
     Discussions about whether to attempt CPR 132-133
     When CPR will not be successful 134-136
     When CPR may be successful 137-141
            Patients who have capacity 137-139
            Patients who lack capacity 140-141
     Resolving disagreements 142
     Recording and communicating CPR decisions 143
     Treatment and care after a DNACPR decision 144-145
     Emergencies and CPR 146
Legal Annex  
Legal Annex Endnotes
Glossary of terms  



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