skip to main content

Capacitous refusal of intensive care escalation — SCE Acute Medicine MCQ

Instant feedback + full explanation. One question, done properly.

ModeratePerioperative and End-of-Life CareCapacitous refusal of intensive care escalationSCE Acute Medicine

A 91-year-old woman with advanced heart failure and frailty is admitted with pneumonia and type 1 respiratory failure. She has capacity and says she would accept antibiotics and ward oxygen but would not want CPR, intubation or transfer to intensive care. Her son asks the team to do everything. What is the most appropriate next step in management?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — Record and respect her capacitous treatment preferences, including escalation limits

A capacitous adult's informed treatment refusal and preferences should be respected, even when relatives disagree. Next of kin do not make decisions for a capacitous patient. DNACPR and escalation planning should be discussed sensitively and documented clearly. The acute medicine point is that ceiling-of-care decisions are clinical and ethical decisions, not family consent forms.

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