It has now been 4 days since admission. Patient remains nil by mouth, minimally responsive, requiring full care and unable to participate in rehab. The multi-disciplinary team discuss again the plan for this patient.
Acknowledge that clinically assisted nutrition and hydration are judged by law to be medical treatments and therefore can be withdrawn if no benefit.
GMC 2010 guidance:
“If there is a reasonable degree of uncertainty about whether a particular treatment will provide overall benefit for a patient who lacks capacity to make a decision, the treatment should be started in order to allow a clearer assessment to be made.”
GMC 2010. Treatment and care towards the end of life: good practice in decision making
The team share their findings from the conversations they have already had with the family
- Daughter wants everything done and concerned about nutrition and hydration
- Wife is still quite shocked and passive in discussions with her daughter taking charge
![Dr Richards reviews the case and considers how to approach the conversation with the family. [See View Text Alternative button for details of text in thought bubble.]](/wp-content/uploads/2020/04/Doc_thought_47564.jpg)
Dr Richards reviews the case and considers how to approach the conversation with the family …
‘His wife is clear that he would not want to be left in a very disabled state, but his daughter is convinced he would have more strength if we started feeding. Although I would predict he is going to remain very disabled, I am going to have to be honest that the future is uncertain. I think it will be important to emphasise that we can start a trial of NG feeding and then we can see if this treatment is providing any improvements to his condition. This will need a clear goal and that should be to see an increasing capacity to participate in rehabilitation over the next 4 weeks, but if we are not seeing any benefits, we’ll need to consider if it is in his best interest to continue. This is likely going to need further discussion to prepare this family for the worst, even if we are still hoping for the best.’
Page last reviewed: 16 Jan 2023
