What to do if…
a hospital asks you to come in urgently to discuss end-of-life decisions for a relative

What to do now

1. Confirm the logistics and the urgency. Ask: “Is this a same-day decision? What happens if I arrive in 2 hours, or tomorrow morning?” If you cannot get there quickly, ask for a phone or video family meeting and the ward’s direct number.
2. Ask who is leading the discussion and what it is about. Request the consultant, the most senior doctor available, or the senior nurse in charge. Ask: “Is this about CPR or DNACPR, a treatment escalation plan or ReSPECT form if used locally, intensive care, ventilation, feeding, antibiotics, or moving to comfort-focused care?”
3. Ask the capacity question early. Say: “Does my relative currently have capacity to make this specific decision?”
   • If they have capacity, ask how the team will support them to decide and how you can support them without speaking over them.
   • If they lack capacity, ask what best-interests process the team is following and whether anyone has legal authority for this decision.
4. Ask the team to check for existing documents or appointed decision-makers. Ask whether the records show:
   • a health and welfare Lasting Power of Attorney in England or Wales
   • a welfare power of attorney in Scotland
   • in Northern Ireland, any document or recorded wish the hospital can take into account
   • an Advance Decision to Refuse Treatment, another advance decision, or an advance care planning record
   • any existing DNACPR form, treatment escalation plan, or ReSPECT form If you have paperwork at home, bring it, send clear photos, or ask someone else to bring it.
5. Bring the right information into the room. Quickly gather:
   • what your relative has said matters most to them
   • any wishes they expressed about ICU, CPR, life support, severe disability, or dying in hospital
   • what they were usually like before this crisis, including memory, mobility, communication, and recent changes
6. Use simple questions to slow the meeting down. Ask:
   • “What is the most likely outcome with this treatment?”
   • “What is the most likely outcome without it?”
   • “What are you most worried may happen in the next 24 to 72 hours?”
   • “Are you recommending for or against CPR or intensive care, and why for this patient?”
   • “If the plan is comfort-focused care, what symptoms will you treat and how will you keep them comfortable?”
7. Ask for specialist support in the meeting. Ask whether the palliative care team is already involved. If it would help your relative or family, ask whether spiritual care, chaplaincy, family liaison, or bereavement support can join or speak with you.
8. If there is no family or you are not being consulted, ask about advocacy. If your relative lacks capacity for a serious medical treatment decision and has nobody appropriate to consult, ask whether an Independent Mental Capacity Advocate should be involved in England or Wales, unless an immediate emergency decision cannot wait. In Scotland or Northern Ireland, ask the hospital what independent advocacy route, if any, applies.
9. If your relative is getting worse and you are not being heard, ask about escalation. In England, ask staff whether Martha’s Rule, Call for Concern, or another rapid-review route is available in that hospital. There is no single national Martha’s Rule number, so check ward posters, the trust website, or ask staff for the local route.
10. If there is disagreement or you feel pressured, escalate calmly. Ask for:

• a second senior review, if available
• the hospital’s patient advice or complaints support route, such as PALS in England
• an ethics or complex-case discussion, if the hospital offers one
• a written summary of the decision, who was involved, and what will happen next