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CPAP Continuation vs Discontinuation in Dying — SCE Palliative Medicine MCQ

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ModerateEnd of Life CareCPAP Continuation vs Discontinuation in DyingSCE Palliative Medicine

A 78‑year‑old man with advanced COPD and severe dyspnoea is dying. His son asks whether continuous positive airway pressure (CPAP) should be continued as his father has used it at home for years. What is the appropriate approach?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: C — If CPAP provides comfort and relieves dyspnoea, continue; if it becomes a burden (e.g. mask discomfort, noise, impeding closeness), gently discontinue with appropriate symptom control.

Explanation lettering: E = shown as A · C = shown as B · B = shown as C · A = shown as E

UK palliative care practice allows withdrawal of non‑invasive ventilation, including CPAP, when it's no longer beneficial or becomes burdensome, and strongly supports symptom control for comfort. NHS England guidance affirms that competent adults may stop NIV when it fails to help or becomes burdensome, with reassurance and appropriate symptom control. The NHS general policy on withdrawing life‑sustaining treatment asserts that treatments may be withdrawn if not in the patient’s best interests, ensuring comfort during the dying process. Option B reflects this nuanced, comfort‑centred, individualised approach. Option A is too rigid; C and D are technology‑focused and ignore goals of care; E wrongly privileges continuation regardless of patient comfort.

Reference: NHS England 'Withdrawal of Non‑Invasive Ventilation at the End of Life' guidelines (2016) and NHS 'Withdrawing treatment' NHS.uk page (2023)