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Advance care planning in acute admission — SCE Acute Medicine MCQ

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ModerateMedicine in the elderlyAdvance care planning in acute admissionSCE Acute Medicine

A 79-year-old woman with frailty and severe aortic stenosis is admitted with pneumonia. She has completed IV antibiotics, is eating poorly and remains bedbound. She says she would not want CPR or ICU admission, but her son asks that everything possible should be done. She has capacity and understands the consequences. What is the most appropriate next step in management?

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Correct answer: C — Respect her capacitous refusal and document an advance care planning discussion

A capacitous adult's informed refusal of treatment must be respected, even when relatives disagree. Acute physicians should document the discussion, treatment escalation plan and DNACPR decision-making clearly. Next of kin do not have authority to override a capacitous patient's decision.

Reference: GMC Treatment and care towards the end of life; NICE NG142