Everyone who is at this stage of their life has the right to privacy, dignity and involvement in the decisions surrounding their care.

Healthcare professionals and all other carers need to respect the wishes and decisions expressed by the individual concerned, or in certain situations next of kin.

This could impact on:

• Pain relief – this can often be a major fear for those at the end stages of life and people with diabetes may be experiencing long-term complications of diabetes, such as neuropathic pain, leg and foot wounds, as well as discomfort following a heart attack or stroke.
• Resuscitation status. This should be reviewed, as per local protocol, as people with diabetes have an up to five-fold increased risk of cardiovascular disease and diabetes is the leading cause of end-stage renal failure.
• Withdrawal of treatment. For those with diabetes, this may involve decisions on whether insulin or tablet therapy (for glucose control or any other associated complication) is continued and whether blood glucose levels are monitored regularly. However symptom control, such as in the case of high or low blood glucose levels, is of paramount importance for the comfort of the individual.
• Withdrawal or choice of food and fluid. Relaxation of dietary control may be considered in those that wish it eg an individual who may have been following a low-fat diet for weight loss. Continuation or commencement of intravenous fluid replacement or parenteral feeding should also be discussed.
• General treatment considerations eg wound dressings or pressure area relief may not be carried out routinely, but should respond to the comfort and needs of the individual.

Reviewed March 2010
Next review September 2011