ABSTRACT
For some, death is the beginning of an afterlife. But for many, death may bring psychological and/or spiritual traumas and regrets that many staff may feel uncomfortable discussing. Palliative care teams and chaplains are usually more experienced in supporting people facing death than most nurses on general wards. Some patients wish to sort out their affairs before dying, such as making their will. It is unwise for nurses to witness patients’ wills, and most employers discourage this. Where possible, patients should be informed of their prognosis, and participate in discussion about end-of-life care. Advance directives (‘living wills’) indicate patients’ wishes, but advance directives are often either not made or not obviously available. Patients have a right to dignified care; they do not, however, have a right to futile treatment. Unfortunately, acute illnesses causing terminal conditions may prevent people understanding explanations, or being able to make decisions. The five key principles of the Mental Capacity Act (Parliament, 2005) provide good guidance for patient involvement in end-of-life issues:
n presumed capacity – everyone is presumed to have capacity to make decisions until proven otherwise;
n individuals are supported in decision-making – all practical help is given before treating patients as lacking capacity to make decisions;
n unwise decisions – individuals retain the right to make what may seem unwise or eccentric decisions;
n best interest – any decision made for or on behalf of a person must be done in their best interest;
n least restrictive option – any action or decision made on behalf of someone else should be the least restrictive of their basic rights and freedom.
