Mr J is an 86 year old man with terminal heart failure and dementia – he develops a chest infection. Despite oral antibiotics and oxygen he steadily worsens and starts to refuse food and choke on fluids. The medical team have to decide whether to start intravenous fluids and intravenous antibiotics or start Mr J on the Liverpool Pathway for palliative care. Mr J’s daughter is keen that everything possible be done for her father including ventilation if necessary but his son says that his father had expressed a wish that if his quality of life worsened he would like to die. Discuss how you would handle this situation.

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