Medicine of the older adult. Discharge, capacity, advance care planning and end of life

• Leaving hospital: Discharge Planning | Discharge to Assess and Intermediate Care | Social Care and Funding | NHS Continuing Healthcare | Care Homes | Supporting Carers
• Capacity and the law: The Mental Capacity Act | Best Interests Decisions | Lasting Power of Attorney and Deputies | Advance Decisions to Refuse Treatment | Deprivation of Liberty Safeguards
• Planning ahead and end of life: Advance Care Planning and ReSPECT | CPR Decisions | Prognosis and Illness Trajectories | Recognising and Caring for the Dying Person | After Death — Certification and the Medical Examiner
• Revision: Discharge, Law and End of Life at a Glance | Spot the Diagnosis | Exam-style Scenarios | Key Points | Guidelines and Further Reading

🩺 Discharge, capacity, advance care planning and end of life — page 6 (the last) of the Medicine of the Older Person chapter. Getting older people home safely and quickly, respecting their choices and legal rights, and planning for the end of life are as important as diagnosing disease. This page covers England and Wales law (Mental Capacity Act 2005); Scotland and Northern Ireland have different legislation. Symptom control at the end of life is in the Palliative Care chapters; the Mental Health Act is in the Psychiatry chapters.
Your four questions for every older patient: What does the person want, and do they have capacity for this decision? What support do they need to leave hospital — and can it be arranged now? Who speaks for them if they can't — an LPA, a deputy, family, an IMCA? Is there a plan for future deterioration, including CPR and preferred place of care?

Discharge Planning

• Start planning on admission — set an expected date of discharge, involve the patient and family, and identify likely needs early.
• Delayed discharges harm older people — deconditioning, infection, delirium and loss of independence; most further assessment is better done at home ("Home First").
• Before discharge:
  • Medically optimised (not necessarily "fully well") — a clear plan for ongoing treatment.
  • Function — mobility, transfers, personal care; equipment (frame, commode, perching stool, hospital bed) in place.
  • Care and support — care package (visits per day), reablement, district nurses, meals, telecare.
  • Medicines — reconciled, changes explained, enough supply, compliance support, Discharge Medicines Service.
  • Follow-up — GP actions, clinic appointments, investigations pending, community services.
  • Communication — a clear discharge summary (diagnoses, changes to medicines and why, delirium, functional status, advance care plans and ReSPECT form, actions for GP) and information for the patient and carers.
  • Transport, keys, heating and food at home; carers informed.
• Self-discharge — assess capacity for the decision; if the patient has capacity, respect it while providing information, safety-netting and follow-up.
• Readmission risk — frailty, polypharmacy, delirium, living alone, poor social support; early community follow-up helps.

Discharge to Assess and Intermediate Care

• Discharge to Assess (D2A) — people who are clinically ready but may need support are discharged, and their longer-term needs are assessed at home (or in a short-term setting) rather than in hospital:

  Pathway	Description
  0	Home with no new support (or simple help — voluntary sector, existing care restarted) — most patients
  1	Home with new support — reablement, rehabilitation or a care package
  2	Short-term bed-based rehabilitation (community hospital, intermediate care beds) before going home
  3	Likely to need long-term care (care home), usually after assessment in a short-term placement

• Intermediate care (NICE NG74) — time-limited (up to about 6 weeks) services to help people recover or avoid admission:
  • Reablement — support at home to relearn daily tasks (social care — free for up to 6 weeks).
  • Home-based intermediate care — rehabilitation by therapists and nurses at home.
  • Bed-based intermediate care — community hospitals or care home beds.
  • Crisis response — urgent community response (within 2 hours) to avoid admission.
• Early Supported Discharge — for stroke and hip fracture — specialist rehabilitation at home.
• Virtual wards / hospital at home — acute care at home with remote monitoring and visits.

Social Care and Funding

• Care Act 2014 (England) — local authorities must:
  • Carry out a needs assessment for anyone who appears to need care and support, and a carer's assessment.
  • Meet eligible needs (national eligibility criteria — unable to achieve two or more outcomes, with significant impact on wellbeing).
  • Promote wellbeing, prevention, information and advice, and safeguarding.
• Social care is means-tested (unlike NHS care, which is free) — financial assessment of income and capital:
  • In England (thresholds set nationally — check current figures), people with capital above an upper limit (currently about £23,250) usually pay the full cost; below a lower limit (about £14,250), capital is disregarded; in between, they contribute.
  • The value of the home is ignored for care at home, and for care home costs if a partner or certain relatives still live there; deferred payment agreements can delay selling the home.
• Direct payments and personal budgets — people can arrange their own care.
• Benefits — Attendance Allowance (over State Pension age with care needs — not means-tested), Pension Credit, Carer's Allowance, Council Tax reductions — many eligible older people don't claim.
• Free services — reablement (up to 6 weeks), intermediate care, aids and minor adaptations under £1,000, NHS-funded nursing care contribution in nursing homes.

NHS Continuing Healthcare

• NHS Continuing Healthcare (CHC) — a package of care fully funded by the NHS (at home or in a care home) for adults whose needs are mainly health needs — a "primary health need" — because of their nature, intensity, complexity or unpredictability. It is not means-tested.
• Process:
  • Checklist — a screening tool (usually after discharge, in the community, once needs are clearer).
  • Decision Support Tool (DST) — a full MDT assessment of 12 care domains (e.g. behaviour, cognition, mobility, nutrition, continence, skin, breathing, drug therapies, altered consciousness).
  • Decision by the Integrated Care Board (ICB); reviewed at 3 months, then yearly.
• Fast Track pathway — for people with a rapidly deteriorating condition that may be entering a terminal phase — completed by an appropriate clinician to arrange care quickly (e.g. to die at home or in a care home); no need for a full DST.
• NHS-funded nursing care (FNC) — a flat-rate NHS contribution for people in nursing homes who need registered nursing care but aren't eligible for CHC.
• Joint packages — some needs met by NHS and some by social care.

Care Homes

• Types:
  • Residential care homes — personal care (washing, dressing, meals, medicines) without on-site nurses.
  • Nursing homes — 24-hour registered nurses for people with nursing needs (complex wounds, PEG feeding, high dependency).
  • EMI / dementia homes — specialist dementia care.
  • Extra care housing and sheltered housing — own flat with care on site.
• The decision to move into a care home — a major life decision; involve the person (capacity assessment for the specific decision), avoid making it in hospital during acute illness where possible (assess after recovery — Discharge to Assess pathway 3), consider alternatives (live-in care, increased package).
• Care home residents — very frail, high rates of dementia (about 70%), polypharmacy, falls; median survival in nursing homes is about 1–2 years.
• Healthcare in care homes — Enhanced Health in Care Homes framework: aligned GP practices, weekly MDT "home rounds", medication reviews, personalised care and support plans, advance care planning, hydration and falls programmes.
• Avoiding unnecessary hospital admission — clear ReSPECT forms, anticipatory medicines, community urgent response, virtual wards; but don't deny admission when it would benefit the person.
• Regulation — Care Quality Commission (CQC) inspects and rates care homes.

Supporting Carers

• Unpaid carers — family and friends provide most care for older people; many carers are themselves older and have health problems.
• Carer strain — exhaustion, depression, physical illness, financial hardship, social isolation; breakdown in the carer's health is a common reason for crisis admissions and care home placement.
• Identify carers — ask "Who helps you?" and "Who do you care for?"; record carers in notes.
• Carer's assessment — a legal right under the Care Act 2014; can lead to support (respite, breaks, training, equipment, direct payments).
• Support — respite care, day centres, sitting services, carers' organisations (Carers UK), Carer's Allowance, information about the person's condition and prognosis, emergency planning ("what if I'm ill?").
• In hospital — involve carers in decisions (with the patient's consent or in best interests), open visiting (John's Campaign), carer passports.
• Young carers and older carers looking after spouses with dementia need particular attention.

The Mental Capacity Act

• Mental Capacity Act 2005 (England and Wales) — applies to people aged 16 and over who may lack capacity to make particular decisions.
• Five statutory principles:
  1. Assume capacity unless it is shown otherwise.
  2. Take all practicable steps to help the person make the decision (hearing aids, interpreters, best time of day, simple information).
  3. An unwise decision does not mean a lack of capacity.
  4. Any act or decision for a person lacking capacity must be in their best interests.
  5. Choose the least restrictive option.
• Capacity is decision-specific and time-specific — a person may be able to decide what to eat but not whether to sell their house; capacity can fluctuate (e.g. delirium — reassess when better, or wait if the decision can wait).
• Assessing capacity (MCA as interpreted by the Supreme Court, 2023):
  • Functional test — can the person:
    • Understand the relevant information?
    • Retain it long enough to decide?
    • Use or weigh it as part of the decision-making process?
    • Communicate the decision (by any means)?
  • Causative nexus — is the inability caused by an impairment of, or disturbance in, the functioning of the mind or brain (e.g. dementia, delirium, learning disability, brain injury)?
• Who assesses — the person proposing the decision or treatment (e.g. the doctor for medical treatment; social worker for placement); document clearly — the decision, information given, how each part of the test was met or not.
• Executive dysfunction — some people can describe risks in conversation but can't apply them in practice ("talk the talk but not walk the walk") — consider evidence of actual behaviour.

Best Interests Decisions

• If a person lacks capacity for a decision (and there is no valid advance decision or authorised LPA making it), the decision-maker acts in their best interests (MCA section 4).
• Best interests checklist:
  • Involve the person as much as possible; consider whether they may regain capacity (can the decision wait?).
  • Consider their past and present wishes and feelings, beliefs and values (written statements, what they said before).
  • Consult others — family, carers, anyone named by the person, LPA or deputy.
  • Don't make assumptions based on age, appearance or condition.
  • For life-sustaining treatment — must not be motivated by a desire to bring about death.
  • Consider the least restrictive option.
• Best interests is not the same as what the family want or what the doctor thinks best medically — it is what is best for this person, given their values.
• Independent Mental Capacity Advocate (IMCA) — must be instructed when a person lacking capacity has no family or friends to consult (other than paid carers) and a decision is needed about serious medical treatment or a change of accommodation (hospital over 28 days, care home over 8 weeks); may be used in safeguarding.
• Disagreements — discuss, second opinions, mediation, ethics committee; the Court of Protection for unresolved serious disputes (e.g. withdrawing clinically assisted nutrition where there is disagreement).
• Emergencies — treat in best interests when there's no time to consult (e.g. life-saving treatment), unless a valid ADRT applies.

Lasting Power of Attorney and Deputies

• Lasting Power of Attorney (LPA) — a legal document made by a person with capacity (the "donor"), appointing one or more attorneys to make decisions if they later lack capacity; must be registered with the Office of the Public Guardian before use.
• Two types:
  • Property and financial affairs — can be used while the person still has capacity (with their permission) as well as after.
  • Health and welfare — can only be used when the person lacks capacity for the decision; covers medical treatment, care, where they live; can include life-sustaining treatment only if the donor specifically gave this authority in the document.
• Check — ask to see the LPA (or check the OPG register); confirm it's registered and what it covers. A health and welfare attorney's decision is binding (if within their authority and in the person's best interests); they can't demand treatment that clinicians don't think is clinically appropriate.
• Enduring Power of Attorney (made before October 2007) — finances only; still valid if registered when the donor loses capacity.
• "Next of kin" has no legal power to consent for an adult — but should be consulted in best interests decisions.
• Court-appointed deputy — appointed by the Court of Protection when someone lacks capacity and has no LPA (usually for finances; health and welfare deputies are rare).
• Encourage LPAs early — e.g. after a dementia diagnosis, while capacity remains.

Advance Decisions to Refuse Treatment

• Advance decision to refuse treatment (ADRT) — made by a person aged 18 or over with capacity, refusing a specified treatment in specified circumstances if they later lack capacity.
• Legally binding if valid (not withdrawn, not overridden by a later LPA covering the same treatment, the person hasn't acted inconsistently with it) and applicable (to the treatment and circumstances now).
• Refusing life-sustaining treatment — the ADRT must be:
  • In writing.
  • Signed and witnessed.
  • Include an explicit statement that it applies "even if life is at risk".
• Can't be used to — demand treatment, refuse basic care (warmth, shelter, hygiene, offering food and drink by mouth), or ask for anything unlawful (e.g. assisted suicide).
• Advance statements — written or spoken statements of wishes, preferences and values (e.g. "I'd like to be cared for at home", religious wishes) — not legally binding but must be considered in best interests decisions.
• If in doubt about validity in an emergency — provide treatment to preserve life while clarifying; Court of Protection if needed.

Deprivation of Liberty Safeguards

• Deprivation of liberty — the "acid test" (Cheshire West, Supreme Court 2014): a person who lacks capacity to consent to their care arrangements is under continuous supervision and control and is not free to leave. It doesn't matter whether the arrangement is in their interests or whether they object.
• Deprivation of Liberty Safeguards (DoLS) — the legal authorisation for deprivations in hospitals and care homes (England and Wales):
  • The hospital or care home (managing authority) applies to the local authority (supervisory body) — an urgent authorisation (self-granted, up to 7 days, extendable once by 7 days) plus a standard authorisation request.
  • Assessments — age, mental health, mental capacity, best interests, eligibility, no refusals.
  • Authorisation up to 1 year; a Relevant Person's Representative is appointed; right of challenge in the Court of Protection.
• In other settings (own home, supported living) — deprivation needs Court of Protection authorisation.
• Liberty Protection Safeguards — planned replacement for DoLS under the Mental Capacity (Amendment) Act 2019, but implementation has been delayed — DoLS remain in force (check current status).
• Mental Health Act vs DoLS — use the Mental Health Act for treatment of a mental disorder where the person objects (see the Psychiatry chapter).
• Restraint (MCA section 6) — only if necessary to prevent harm and proportionate to the risk; includes physical restraint, bed rails, locked doors, sedation and covert medication.

Advance Care Planning and ReSPECT

• Advance care planning (ACP) — a voluntary process of discussion between a person, their family and professionals about future care, in case they lose capacity or become very unwell.
• When — at diagnosis of a life-limiting illness (dementia, heart failure, COPD, cancer), with frailty, after hospital admissions, care home admission, or when the "surprise question" is answered "no".
• What to discuss — understanding of illness, what matters most, fears and hopes, preferred place of care and death, treatments they would or wouldn't want (hospital admission, ICU, tube feeding, antibiotics, CPR), who should speak for them (LPA), spiritual and cultural needs, organ donation.
• Outputs — advance statements, ADRT, LPA, ReSPECT form, personalised care and support plan; share them (GP record, Summary Care Record, ambulance services, care home).
• ReSPECT (Recommended Summary Plan for Emergency Care and Treatment):
  • A summary of personalised recommendations for a person's clinical care in a future emergency when they can't express their choices.
  • Includes what matters to the person, focus of care (prioritise sustaining life vs prioritise comfort — on a scale), specific treatments to consider or avoid, and a CPR recommendation.
  • Not legally binding, but should be followed unless circumstances change; travels with the person; reviewed when health changes.
• Good conversations — ask permission, explore understanding, give honest information in plain language, explore goals, recommend a plan, check understanding, document; it is a process over time.

CPR Decisions

• CPR in frail older people — survival to discharge after in-hospital cardiac arrest is low (about 1 in 5 overall, and much lower in frail people with multiple comorbidities); survivors may have brain injury, rib fractures and loss of function.
• DNACPR (Do Not Attempt CPR) decision — applies only to CPR; all other treatment continues as appropriate.
• Making the decision (BMA, Resuscitation Council UK and RCN joint guidance):
  • If CPR would not be successful (clinically futile), a DNACPR decision can be made by the senior clinician — but the patient (or those close to them) must be informed and the decision explained, unless this would cause physical or psychological harm (a high bar) (Tracey case, Court of Appeal 2014).
  • If CPR might succeed, the decision depends on the balance of benefits, burdens and risks — discuss with the patient (or, if lacking capacity, best interests with LPA, family).
  • A patient with capacity can refuse CPR; they cannot demand CPR that won't work, but should be offered a second opinion.
• Don't base decisions on age, frailty scores or disability alone — individual assessment (blanket DNACPR policies are unlawful).
• Document — on the agreed form (e.g. ReSPECT), with the reasons, who was involved, and review date; communicate on transfer and discharge.
• Implantable cardioverter–defibrillators — discuss deactivation as part of end-of-life planning (shocks cause distress near death).

Prognosis and Illness Trajectories

• Prognosis is uncertain, especially in frailty and organ failure — use "hope for the best, prepare for the worst", and plan early.
• Indicators of declining health (e.g. SPICT, Gold Standards Framework):
  • Two or more unplanned admissions in 6 months.
  • Declining performance status and increasing dependence.
  • Persistent symptoms despite optimal treatment.
  • Unintended weight loss over 3–6 months; low albumin.
  • The person or family asking for palliative care, or wanting to stop treatments.
  • Disease-specific markers (e.g. advanced dementia unable to walk or communicate; heart failure with breathlessness at rest).
• Hospital admission is itself a marker — about a third of older people admitted as an emergency die within a year (higher with frailty).
• Palliative care is based on need, not diagnosis — involve specialist palliative care for complex symptoms or needs; generalist palliative care is part of geriatric medicine.

Recognising and Caring for the Dying Person

• Recognising that someone may be dying (last days of life, NICE NG31):
  • Increasing weakness and fatigue, mostly bed-bound, sleeping more.
  • Reduced or no intake of food and fluids, difficulty swallowing medicines.
  • Reduced consciousness, confusion or agitation.
  • Changes in breathing (Cheyne–Stokes, noisy "death rattle" from secretions), mottled cool peripheries, falling urine output.
  • Exclude reversible causes where appropriate (infection, hypercalcaemia, drug toxicity, dehydration, hypoglycaemia) — and acknowledge uncertainty (some people improve).
• Communicate — talk with the person (if able) and family honestly about dying; check understanding, wishes and spiritual needs; preferred place of death (rapid discharge home or to a care home — CHC Fast Track).
• Individualised care plan for the last days of life — review daily:
  • Stop unnecessary medicines, blood tests, observations and interventions.
  • Hydration — support oral intake (mouth care, sips); consider clinically assisted hydration individually — discuss benefits and harms.
  • Anticipatory medicines ("just in case") — for pain (opioid), breathlessness (opioid, midazolam), agitation (midazolam; levomepromazine or haloperidol for delirium), nausea (haloperidol, levomepromazine, cyclizine), respiratory secretions (glycopyrronium, hyoscine butylbromide) — usually subcutaneous; syringe driver if needed (see the Palliative Care chapters).
  • Mouth care, pressure care, positioning, continence, privacy, family presence.
• Care after death — support for family and staff, verification of death, respect for religious and cultural wishes, bereavement information.

After Death — Certification and the Medical Examiner

• Verification of death — confirming death (no central pulse or heart sounds for at least 1 minute, no breath sounds, fixed dilated pupils unresponsive to light, no response to painful stimulus) — can be done by trained nurses and paramedics; document time.
• Medical examiner system (statutory in England and Wales since September 2024):
  • All deaths not referred to the coroner are reviewed by an independent medical examiner, who scrutinises records, discusses the cause of death with the attending doctor, and speaks with the bereaved family (raising any concerns).
  • The attending practitioner (any doctor who attended the person during their final illness) completes the Medical Certificate of Cause of Death (MCCD).
• Writing the cause of death — Part 1a (the disease or condition leading directly to death), 1b and 1c (underlying causes), Part 2 (contributing conditions); avoid modes of dying alone ("cardiac arrest", "old age" only in specific circumstances — "frailty of old age" is acceptable only if the patient was 80 or over, well known to the doctor, and no specific disease is identifiable).
• Refer to the coroner if death is unnatural or the cause is unknown — e.g. falls and fractures (including hip fracture — a death after a fall is an unnatural death), violence, neglect (including self-neglect), suicide, poisoning, industrial disease (asbestosis, mesothelioma), during or after surgery or procedures, possible medical error, in state detention (including under the Mental Health Act; DoLS no longer requires referral since 2017), unknown identity.
• Cremation — form completed by the attending practitioner (and reviewed by the medical examiner); pacemakers and some implants must be removed.

Discharge, Law and End of Life at a Glance

Spot the Diagnosis

Exam-style Scenarios

1. An 86-year-old woman with mild dementia has recovered from pneumonia. She wants to go home to her flat, where she lives alone. Her daughter wants her to go into a care home "for her safety". The OT notes she can wash and dress with prompting but forgets to eat.
Answer: Discharge decision involving capacity and risk.

• Assess her capacity for the decision about where to live (understand, retain, weigh options and risks, communicate) — with support (good time of day, simple information).
• If she has capacity — her decision stands, even if unwise; arrange support (care package with meal prompts, telecare, Discharge to Assess pathway 1).
• If she lacks capacity — best interests decision (her wishes and values, consult daughter, least restrictive option — home with support first); IMCA if no family; explain to the daughter that next of kin can't decide unless she holds an LPA.

2. A 90-year-old man with severe frailty (CFS 8) and recurrent aspiration pneumonia is admitted again. He has capacity and says, "I don't want to go back to intensive care or be resuscitated. I just want to be comfortable and go home."
Answer: Advance care planning with a capacitous patient.

• Respect his wishes; complete a ReSPECT form (focus on comfort, no ICU, DNACPR) and document his reasons; involve family with his consent.
• Offer him the chance to make an ADRT (written, signed, witnessed) and/or a health and welfare LPA.
• Plan for home — eating and drinking with acknowledged risks, anticipatory medicines, community palliative care, GP and ambulance informed; CHC Fast Track if he's deteriorating.

3. A 79-year-old woman with dementia in a care home repeatedly tries to leave. Staff keep the front door locked with a keypad and check on her every 30 minutes. She lacks capacity to decide on her care arrangements.
Answer: Deprivation of liberty.

• She is under continuous supervision and control and not free to leave — the acid test is met.
• The care home must grant an urgent authorisation (if needed) and apply to the local authority for a standard DoLS authorisation.
• Ensure arrangements are the least restrictive possible; a Relevant Person's Representative is appointed; she or her representative can challenge in the Court of Protection.

4. An 88-year-old man is admitted with sepsis. The registrar records a DNACPR decision at 3 am because "CPR would not work given his frailty", but doesn't inform the patient, who has capacity, or his family.
Answer: DNACPR decision without communication.

• The clinical judgement may be correct, but the patient (who has capacity) must be informed and the decision explained, unless doing so would cause physical or psychological harm (Tracey, 2014).
• Have a sensitive discussion as soon as practicable (offer a second opinion if he disagrees); inform the family with his consent.
• Make sure the DNACPR decision doesn't reduce other appropriate treatment for sepsis; document on the ReSPECT form.

5. A 93-year-old woman died on the ward 10 days after surgery for a hip fracture sustained in a fall at home. The F1 doctor asks if they can complete the death certificate as "bronchopneumonia".
Answer: Death requiring coroner referral.

• A death following a fall and fracture is an unnatural death — it must be referred to the coroner (via the medical examiner office).
• The cause of death would usually include the fracture and the fall (e.g. 1a bronchopneumonia, 1b fractured neck of femur — but the coroner decides).
• Explain the process sensitively to the family; the medical examiner will also speak with them.

Key Points

• Plan discharge from admission; Home First — assess long-term needs at home (Discharge to Assess).
• Intermediate care and reablement are time-limited and free; social care is means-tested.
• CHC is NHS-funded for a primary health need; Fast Track for rapidly deteriorating patients near the end of life.
• Identify and support carers — carer's assessment under the Care Act.
• MCA — assume capacity; help the person decide; unwise decisions are allowed; best interests; least restrictive.
• Capacity is decision- and time-specific — understand, retain, use or weigh, communicate, caused by impairment of mind or brain.
• Next of kin has no legal authority — LPAs and deputies do.
• Health and welfare LPA works only when capacity is lost; life-sustaining decisions only if expressly authorised.
• ADRT refusing life-sustaining treatment — written, signed, witnessed, "even if life is at risk".
• IMCA for people without family facing serious treatment or a move.
• DoLS — continuous supervision and control and not free to leave; LPS not yet implemented.
• Advance care planning early; ReSPECT summarises emergency recommendations.
• DNACPR is only about CPR; inform the patient or family; no blanket decisions.
• Frailty and dementia follow a prolonged dwindling trajectory — plan with uncertainty.
• Last days — individualised plan, stop the non-essential, anticipatory medicines, support the family.
• Deaths after falls and fractures go to the coroner; the medical examiner reviews all other deaths.

Guidelines and Further Reading

• Department of Health and Social Care: Hospital discharge and community support guidance (Discharge to Assess)
• NICE NG27: Transition between inpatient hospital settings and community or care home settings for adults with social care needs
• NICE NG74: Intermediate care including reablement
• Care Act 2014 and statutory guidance
• National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care
• Mental Capacity Act 2005 and Code of Practice; NICE NG108: Decision-making and mental capacity
• Office of the Public Guardian: Lasting Power of Attorney guidance
• Resuscitation Council UK: ReSPECT process
• BMA, Resuscitation Council UK and RCN: Decisions relating to cardiopulmonary resuscitation
• NICE NG31: Care of dying adults in the last days of life; NICE NG142: End of life care for adults — service delivery
• Supportive and Palliative Care Indicators Tool (SPICT); Gold Standards Framework Proactive Identification Guidance
• Department of Health and Social Care: Death certification reforms and the statutory medical examiner system (2024)
• BNF — for current doses