What to do if…
you are asked to make medical decisions for a relative who cannot communicate their wishes

What to do now

1. Ask what decision is needed in the next hour.
   Say: “What decision has to be made now, what can wait, and what will happen while we clarify this?”

2. Ask whether your relative can decide this specific issue.
   Say: “Has their capacity for this decision been assessed, and can anything be done to help them take part, even partly?”

3. Ask staff to check for any recorded wishes or legal authority.
   Ask whether the notes, GP record, care home record, ambulance record, family papers, or digital care plan mention:

   • an advance decision, advance refusal, living will, or Advance Decision to Refuse Treatment;
   • a Health and Welfare Lasting Power of Attorney in England and Wales, or the relevant welfare attorney, guardian, or power where your relative is being treated;
   • a ReSPECT form, emergency care plan, treatment escalation plan, or DNACPR decision.

4. Clarify what must be followed and what still needs judgement.
   Say: “Is there anything legally valid and applicable that the team must follow, or are you asking us what they would have wanted?”
   If there is no clear directive or authorised decision-maker, clinicians usually make the treatment decision under the applicable capacity law and clinical guidance, while consulting people close to the patient.

5. Ask who is responsible for the decision today.
   Say: “Who is the responsible consultant or senior clinician today, and who should the family speak to for a joined-up plan?”

6. Ask for a structured conversation and written documentation.
   Say: “Can we have a short meeting or phone call with the senior clinician and nurse in charge, and can the reasoning and plan be documented in the notes?”
   In England and Wales this may be described as a best-interests discussion; elsewhere the wording may differ.

7. Give the team the information only you may know.
   Prepare a short list you can read out:

   • anything your relative said about CPR, intensive care, ventilation, feeding tubes, dialysis, hospitals, or comfort-focused care;
   • what mattered most to them, such as independence, being aware of family, avoiding suffering, faith, dignity, or being at home if possible;
   • outcomes they would probably find unacceptable, such as permanent unconsciousness or survival with severe burdens they had clearly said they would not want;
   • any disagreements in the family about what they would have wanted.

8. Ask the team to separate clinical options from family views.
   Say: “Which options are clinically appropriate, and for each one, what are the likely benefits, burdens, and next steps?”
   Ask them to explain comfort-focused care, limited treatment, escalation to intensive care, and CPR only where those options are actually being considered.

9. Use hospital support early.
   Ask to speak to the palliative care team, even if treatment is still continuing. Ask for chaplaincy or spiritual care if that would help your relative or family. If communication is breaking down, ask for PALS in England or the hospital’s equivalent patient advice, liaison, or complaints service.

10. If there is nobody suitable to consult, ask about advocacy safeguards.
    In England and Wales, ask whether an Independent Mental Capacity Advocate should be involved for serious medical treatment. In other parts of the UK, ask what local advocacy safeguard applies.