Article Text

Ethics and the Law: Conflict with Relatives over Treatment
  1. Rob George and
  2. Bridgit Dimond
  1. Ethical aspects: Rob George, Consultant in Palliative Medicine, Guy’s and St Thomas’ NHS Foundation Trust. Legal aspects: Bridgit Dimond, Emeritus Professor, University of Glamorgan


What constitutes a ‘good’ death is the issue that lies at the heart of palliative and end-of-life care. The situation highlighted in this article’s Case scenario (see box) is a common occurrence in all care settings. At the centre of the case is a 75-year-old woman, well known to her care home, who is becoming increasingly distressed. She has been assessed as being in the final stages of her disease and is considered to be experiencing ‘terminal’ restlessness. The management of this ‘symptom’ causes conflict between the family and the care home staff. The case highlights the ethical and legal issues that arise when relatives disagree with a plan of care and act in a manner contrary to that which clinicians believe is in the patient’s best interests. The article exposes the problem of managing conflict with families. This case is complicated by the fact that the woman’s mental capacity fluctuates. The article examines the legal aspects of the case before examining the ethical implications, i.e. separating facts from values. It also asks practitioners to question what they are trying to achieve in terms of outcomes when caring for dying people. Conflicts of interest: none

  • Best interests
  • End-of-life management
  • Managing conflict
  • Terminal agitation

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