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Promising Place of Death — SCE Palliative Medicine MCQ

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ModerateCommunication & EthicsPromising Place of DeathSCE Palliative Medicine

A 70-year-old man with advanced COPD asks his palliative care nurse to promise that he will not die in hospital. What is the most appropriate response?

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Correct answer: AAcknowledge his strong preference, explain that you will do everything possible to support his wish, but be honest that circumstances sometimes change — document his preference clearly in the care plan

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

Option A is correct. UK palliative care guidance (NICE NG31) highlights that prognostication is inherently uncertain and that professionals must engage in shared decision‑making, acknowledging and documenting a patient’s wishes while being honest about potential limitations. The Ambitions for Palliative and End of Life Care framework reinforces that honest, sensitive conversations and designing care around the person’s preferences—even amid uncertainty—are essential. Option B is inappropriate because absolute promises cannot be guaranteed in uncertain clinical contexts. Option C needlessly undermines hope and lacks individualized care. Options D and E dismiss the patient’s autonomy and fail to uphold person‑centred, ethical palliative care.

Reference: NICE NG31 (2015) Care of dying adults in the last days of life; NHS England (2022) Ambitions for Palliative and End of Life Care (2nd edition), https://www.nice.org.uk/guidance/ng31/chapter/Recommendations