End of life care and tissue donation

Question 1

What rules are currently in place regarding refusal of life-sustaining treatment?

Answer 1

A competent patient can refuse any treatment, make an advance refusal of treatment (ART) or appoint a proxy decision maker
Refusal of treatment includes withholding and withdrawing treatment (including refusing artificial feeding or mechanical respirator)

Question 2

When is withdrawing or withholding life-prolonging treatment acceptable?

Answer 2

If competent patient requested it: special safeguards must be in place
If it is best for the patient
If the treatment is futile

Question 3

Under what ethical principle can giving treatment that may cause a patients death acceptable?

Answer 3

Under the doctrine of double effect
Explains the permissibility of an action that causes a serious harm, such as the death of a human being, as a side effect of promoting some good end

Question 4

What are the basic ethical rules regarding tissue donation?

Answer 4

All tissues have to be used appropriately (all human cells, so including blood or saliva)
You need written permission to use patients’ tissues for anything other than their own treatment or investigation (e.g. donation, research)

Question 5

What is the current guidance on cadaveric tissue donation?

Answer 5

Members of public are encouraged to make clear if they are ok with the use of their tissues after their death (e.g. on driving licence application)
If a patient is close to death and their views cannot be determined, you should explore this with those close to the patient