Complex or uncertain healthcare decisions
Clear, balanced information when treatment decisions are difficult or disputed.
When decisions are hard
Some treatment decisions involve uncertainty, differing views, or difficult questions about benefits, burdens and what a person said they wanted. Our specialist nurses offer balanced information to help individuals, families and attorneys work through these discussions.
Questions about an advance decision
An advance decision to refuse treatment (ADRT) may be questioned over whether it is valid, whether it applies to the situation, or what it means. If there is genuine doubt, doctors can give treatment needed to prevent death or serious deterioration while the question is resolved, sometimes by the Court of Protection. We explain the legal requirements and help you prepare focused questions for the treating team.
Life-sustaining treatment
Decisions about treatments such as ventilation, resuscitation, dialysis or antibiotics can be clinically and ethically complex. We explain the terminology, how decisions are made, and how much weight the person’s wishes should carry.
Clinically assisted nutrition and hydration (CANH)
CANH, such as feeding through a tube or fluids through a drip, is classed in law as medical treatment. It can be refused in a valid advance decision. Decisions about starting, continuing or stopping it depend on the person’s circumstances, their wishes, the clinical evidence and the legal requirements. Where everyone agrees and the right processes are followed, a court application is not usually needed. Disputed cases may need specialist advice or the Court of Protection.
Disagreement about best interests
People may understand a person’s wishes differently. We explain the Mental Capacity Act framework, clarify who has which role, and help you find the right way to resolve disagreements.
Voluntarily stopping eating and drinking (VSED)
VSED can raise difficult questions about capacity, whether the decision is freely made, illness, symptom management and professional responsibilities. We offer balanced information about the issues and the professional support available. We do not give instructions for hastening death.
How we can help
Our specialist nurses can:
- listen to your concerns
- explain the relevant concepts and terms
- help you understand what existing planning documents mean for the decision
- help you prepare questions for meetings with the healthcare team
- tell you when an independent advocate, legal advice or a further clinical assessment may help
We do not direct treatment or guarantee an outcome.
Frequently asked questions
What if clinicians are not following my relative’s wishes?
Start by establishing what your relative said, how it was recorded, and whether there is a valid advance decision that applies, or an attorney with the relevant authority. Written wishes, such as an advance statement, must be considered in any best interests decision even though they are not legally binding. You can ask for a meeting with the consultant, a second opinion, or a formal review. We can help you work out what to ask and where to go next.
Can relatives insist on treatment continuing?
No. Being next of kin does not give legal authority to demand treatment. Doctors do not have to provide treatment they judge is not clinically appropriate, even if the patient, a relative or an attorney asks for it. However, the views of family and others close to the person must be taken into account in any best interests decision.
Can CANH be withdrawn?
Yes, in some circumstances. It can be lawful when it is no longer in the person’s best interests, or when they have refused it in a valid advance decision that applies, provided the legal and clinical requirements are followed. Disputed cases may need specialist advice or the Court of Protection.
Take the next step
You don’t have to face uncertainty without information. Contact us to explore the issues and prepare for your next conversation with the professionals involved.
Send us an enquiry