A 92-year-old with end-stage dementia is admitted with aspiration pneumonia. The patient lacks capacity. One daughter insists on 'everything including ITU', the son wants comfort care. How will you proceed?

Question

Accepted Answer

I'd approach this carefully. First confirm decision-specific lack of capacity under the MCA, then check for any ADRT, lasting power of attorney for health, and review prior wishes via GP and community palliative records. I'd then convene a best-interests meeting with both family members, the nurse in charge and ideally palliative care. I'd be honest about the clinical picture: end-stage dementia plus aspiration pneumonia carries very high mortality, and ITU would not extend meaningful life — it would add harm without benefit. I'd frame the conversation around benefits and burdens, not 'doing everything' versus 'doing nothing', and present a comfort-focused care plan that still treats reversible distress. If disagreement persists I'd offer a second consultant opinion, involve the clinical ethics committee, and consider an IMCA. Throughout I'd document on ReSPECT, write a clear best-interests rationale, and ensure both family members feel heard even if the final clinical decision is mine and the consultant's.

Family disagreement about end-of-life care

Framework checklists