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Ceiling of care decision — SCE Acute Medicine MCQ

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EasyPerioperative, Safety and End-of-Life CareCeiling of care decisionSCE Acute Medicine

A 51-year-old man presents with postoperative deterioration, treatment refusal or advanced illness. Relevant history includes recent surgery, frailty or a governance issue. On assessment, physiology and communication context require senior decision-making. Investigations show advanced dementia, recurrent aspiration and prior wish to avoid ICU. What would you advise this patient?

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Correct answer: C — Discuss treatment escalation limits and focus on comfort alongside active ward care

The key discriminator is that advanced dementia, recurrent aspiration and prior wish to avoid ICU, which makes Discuss treatment escalation limits and focus on comfort alongside active ward care the single best answer. Assess capacity for this specific decision is less appropriate because it does not address the dominant acute risk in the vignette; Offer safety-netted admission with shared decision-making would fit a different presentation or later stage of care. Discuss escalation limits and focus on comfort alongside active care and Explain that active treatment and palliative care can run together are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: GMC end-of-life guidance; NICE NG31