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uk Death, bereavement & serious family crises no advance directive • no clear directive • making decisions for relative • asked to decide treatment • end of life decisions • dying family member hospital • best interests decision • mental capacity unclear • no living will found • no power of attorney • family disagreement risk • code status uncertainty • resuscitation decision pressure • life support decision • palliative care questions • sudden deterioration • overwhelmed next of kin • hospital ward phone call

What to do if…
you are asked to make medical decisions for a dying relative and there is no clear directive

Short answer

Ask the clinical team to treat this as a best-interests decision and to hold a family/decision meeting. Your key role right now is to share what your relative would have wanted and valued.

Do not do these things

  • Do not agree to major decisions while you feel rushed, confused, or alone—ask for a short pause and a clearer explanation.
  • Do not assume “next of kin” gives you legal decision-making power—treatment decisions are made by clinicians unless there’s a valid ADRT or a Health & Welfare LPA.
  • Do not argue in corridors or by group chat while staff are waiting—ask for one agreed family spokesperson for communication.
  • Do not make decisions based on guilt, family pressure, or “what we can live with” instead of what your relative would have wanted.
  • Do not sign or consent to something you do not understand—ask staff to explain it in plain language and repeat it back to them.

What to do now

  1. Ask two immediate questions (and write down the answers):
    • “Does my relative have capacity to decide this right now?”
    • “Is there any record of an Advance Decision to Refuse Treatment (ADRT), a Health & Welfare Lasting Power of Attorney (LPA), or an emergency care plan (for example ReSPECT or similar) or a DNACPR decision?”
  2. Clarify what must be followed vs what must be decided.
    • If there’s a valid and applicable ADRT, clinicians should follow it.
    • If there’s a registered Health & Welfare LPA, the attorney can usually make health decisions once the person lacks capacity (and may be able to decide about life-sustaining treatment if that authority was granted).
    • If neither exists, clinicians make treatment decisions in the person’s best interests, consulting those close to them.
  3. Ask who the responsible clinician is for today.
    Say: “Who is the responsible consultant/clinician for decisions today, and who should I speak to for a joined-up plan?”
  4. Request a best-interests meeting (today if possible).
    Ask for a short, structured discussion with the responsible clinician and nurse in charge. Say: “Please treat this as a best-interests decision and document the reasoning and plan in the notes.”
  5. Bring the information staff actually need (what your relative would choose).
    Prepare 5–10 bullet points you can read out:
    • What your relative said in the past about ICU, ventilation, CPR, feeding tubes, dialysis, or “keeping me comfortable”.
    • Their values (independence, avoiding suffering, religious beliefs, priorities like “time with family”).
    • What outcomes they would (and would not) accept (for example, permanent unconsciousness or severe brain injury).
  6. Ask for the options in a simple “if we do X, likely next steps are…” format.
    Ask the team to compare:
    • Comfort-focused care (symptom relief and avoiding burdensome interventions)
    • Limited treatment (some treatments but not escalation to ICU/CPR)
    • Full escalation (ICU/ventilation/CPR where clinically appropriate)
      Then ask: “Which option best matches their condition and likely benefits vs burdens?”
  7. If there’s family disagreement, contain it and slow the pressure.
    • Ask the team to document differing views and to speak with family members separately if needed.
    • Ask for one named point of contact in the family, and one named senior clinician on the ward.
  8. Use hospital support that exists for exactly this situation.
    • Ask to speak to the Palliative Care Team (even if treatment continues).
    • Ask for Chaplaincy/spiritual care if relevant (they support any faith or none).
    • If communication is breaking down, ask how to contact PALS (Patient Advice and Liaison Service).
  9. If there is no appropriate family/friend to consult, ask about an IMCA (England & Wales).
    If there’s nobody suitable to speak for them, ask whether an Independent Mental Capacity Advocate (IMCA) should be involved for certain serious decisions as a safeguard.

What can wait

  • You do not need to decide “the perfect choice” right now—focus on the next decision in front of you.
  • You do not need to resolve inheritance, funeral planning, or family conflicts today.
  • You do not need to draft a legal document right now; concentrate on capturing your relative’s wishes and getting them recorded in the notes.
  • You do not need to answer every family message—pick one or two people to update others.

Important reassurance

Being asked these questions can feel like you’re being handed responsibility for someone’s life. In reality, you are helping the team understand who your relative is and what they would consider acceptable. Feeling upset, foggy, or guilty is common—and it’s a sign you need clarity and support, not that you’re doing something wrong.

Scope note

This is first-steps-only guidance for the next hours and days. If the situation becomes prolonged, contested, or legally complex, the clinical team can escalate internally (senior review and formal dispute-resolution processes) and—if needed—seek legal direction.

Important note

This guide is general information, not legal or medical advice. Hospital processes vary across the UK, and Scotland and Northern Ireland have different legal frameworks from England & Wales. If you are unsure, ask the responsible clinician to explain what applies where your relative is and to document the plan clearly in the medical notes.

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