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Patient Wishes as Family Meeting Anchor — SCE Palliative Medicine MCQ

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ModerateCommunication & EthicsPatient Wishes as Family Meeting AnchorSCE Palliative Medicine

A dying inpatient in England lacks capacity to decide about a proposed treatment. There is no valid and applicable advance decision and no health and welfare attorney with authority for the decision. During a family meeting, three relatives advocate different options, each based mainly on what they personally want. Which approach should the registrar use to anchor the discussion?

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Correct answer: AElicit the patient's known wishes, values and preferences and structure the best-interests discussion around them

The correct answer is A. When a dying adult lacks capacity, the family meeting should help the clinical decision-maker determine the patient's best interests. NICE recommends consulting relatives to establish the patient's past and present wishes, feelings, beliefs, values and preferences, placing these at the heart of the process. These factors are central but, without an applicable advance decision or authorised attorney, are not automatically determinative. Relatives provide evidence about the patient; they do not decide according to their own preferences. Restricting attendance solely because the family is large may exclude useful information. Neither the principal carer nor a majority of relatives has automatic decision-making authority. The responsible clinician must make the treatment decision but should not do so without appropriate consultation and consideration of the patient's perspective.

Reference: National Institute for Health and Care Excellence. Decision-making and mental capacity (NG108), recommendations 1.1.78–1.1.88: best-interests decision-making and involvement of family members. 2018. https://www.nice.org.uk/guidance/ng108/chapter/recommendations