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Treatment escalation planning in frailty — SCE Acute Medicine MCQ

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HardEnd-of-Life Care and Patient SafetyTreatment escalation planning in frailtySCE Acute Medicine

A 91-year-old woman with severe frailty, advanced dementia and recurrent aspiration is admitted with pneumonia and type 1 respiratory failure. She lacks capacity. Her daughter reports that the patient repeatedly said she would not want intensive care or machines if recovery was unlikely. NEWS2 is 9 despite antibiotics and oxygen. What would you advise this patient’s family?

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Correct answer: E — Discuss a best-interests plan focused on ward care and comfort if deterioration continues

When a patient lacks capacity, decisions should be made in best interests, incorporating prior wishes, values and clinical proportionality. A treatment escalation plan can appropriately focus on ward-based active treatment and comfort if burdensome escalation is not consistent with the patient's values. Relatives do not sign a refusal unless they hold relevant legal authority, but their knowledge of the patient is highly relevant. The pearl is that ceiling-of-care decisions are active clinical plans, not abandonment.

Reference: Mental Capacity Act 2005; NICE NG31; GMC treatment and care towards end of life