1.3 Describe conflicts and legal or ethical issues that may arise in relation to death, dying or end of life care

This guide will help you answer 1.3 Describe conflicts and legal or ethical issues that may arise in relation to death, dying or end of life care.

Caring for people who are dying presents workers with many challenging situations. These situations can lead to conflict or difficult decisions. This is because people have personal beliefs and values. The law and professional responsibilities must come first, but there are times when these do not match a person’s wishes. Exploring these conflicts will help you respond to them professionally and safely.

What is Meant by Death, Dying and End of Life Care

End of life care is support for people who are in the last months or years of their life. The aim is to help them live as well as possible until they die and to die with dignity. End of life care takes in physical, emotional, social and spiritual needs. It may take place in different settings such as a care home, hospital or the person’s home.

Death and dying can bring out strong feelings in people. Cultural, personal and religious differences often shape these feelings. Health and social care workers play a key role in making sure care is respectful, compassionate and safe.

Legal Issues That May Arise

Laws set the minimum standards for practice. Failing to meet legal duties can lead to criminal or civil penalties. Some common legal problems linked to death and dying are:

Mental Capacity

The Mental Capacity Act 2005 applies in England and Wales. It sets out rules for how to support people who may not be able to make their own choices. This might include an older person with dementia or a person in a coma.

If a person cannot decide about their care or treatment, the law says you must act in their best interests. Workers must:

• Try every way to help the person understand and make a choice
• Never assume someone cannot decide without checking properly
• Involve family or those close to the person if possible

There can be problems if family and professionals disagree on ‘best interests’. Disagreements may end up in court if they cannot be resolved.

Consent to Treatment

Consent means agreeing to something with full knowledge of what it involves. Consent is a legal requirement for all medical or personal care. Someone at the end of life might:

• Refuse life-saving treatment
• Want more pain relief, even if it shortens life

If a person has capacity, their wishes about their care must be respected. This can mean accepting a decision that professionals or relatives do not agree with. Forcing treatment on someone who has said no is a crime.

Advance Decisions and Advance Statements

An advance decision (sometimes called a living will) is a legal statement where someone says what treatments they do not want if they lose capacity in the future. For example, they may refuse CPR if their heart stops.

A valid advance decision:

• Must be made when the person has capacity
• Must state exactly what treatments are refused
• Cannot ask for anything illegal (such as euthanasia)

Health and social care staff must follow a valid advance decision if it applies.

An advance statement is less formal. It covers wishes or preferences about care but has no legal force. Staff should consider it, but do not have to follow it.

Do Not Attempt CPR Decisions (DNACPR)

Some people make a DNACPR decision. This means they do not want cardiopulmonary resuscitation (CPR) if they stop breathing or their heart stops.

Making and following DNACPR decisions can lead to:

• Disagreements with families who may want everything done to revive their loved one
• Staff worries about what to do if there is a challenge

Such decisions must be made based on the person’s wishes and clinical advice. Workers must check for the paperwork and be clear about the legal process set out by policy.

Withholding or Withdrawing Treatment

The law states that doctors can stop or not start treatment if it will not benefit the person or if the person has refused it. However, relatives may feel this is unfair or wrong. Such actions, if poorly managed, could be seen as neglect or abuse.

Situations like these should be handled with care, open discussion, and good record-keeping.

Euthanasia and Assisted Suicide

In the UK, euthanasia and assisted suicide are illegal. Helping someone to die carries criminal penalties.

Some people may ask for help to die. You must not agree to or encourage this. Listen to their wishes, offer support, and seek help from experienced staff or medical professionals.

Duty of Care and Negligence

All health and social care workers have a duty of care. This means following safe working practices and acting in the interests of those you support. Failing in your duty could be seen as negligence (not taking proper care).

When a death occurs, the actions of staff might be investigated:

• Was everything done to relieve pain?
• Were correct procedures followed?
• Was the person’s dignity respected?

Failing here could lead to disciplinary action or even criminal investigation.

Reporting and Documentation

When someone dies, there are legal rules about:

• Notifying the right authorities
• Recording the cause of death
• Handling personal effects

If there are unusual or unexpected circumstances, the death may have to be reported to the Coroner. Not following these rules could delay funerals or lead to legal trouble.

Ethical Issues in End of Life Care

Ethics refer to what is right and wrong from a moral point of view. Health and social care involves many ethical principles, including respect, dignity, autonomy, and justice. These can come into conflict when caring for dying people.

Respecting Autonomy

Autonomy means the right of people to make their own decisions. Even if they are seriously ill or dying, people should decide as much as they can. Staff may face tension when:

• The person refuses treatment, but staff or family think it is needed
• The person wants choices others do not support

Accepting a decision you may not agree with can be hard but is central to good care.

Maintaining Dignity

Dignity is about respecting a person’s value as a human. End of life care must always protect dignity. This can include:

• Keeping the person clean and comfortable
• Allowing privacy
• Supporting their wishes around when and how they die

There can be conflicts if staff are under pressure, lack resources, or have different views about what dignity means.

Confidentiality

Confidentiality is about keeping private information secure. When someone is dying, family and friends often want updates or answers. Conflict can occur if:

• A person’s wishes for privacy differ from family’s wishes
• Cultural values differ about who should know information

By law, confidentiality can only be broken where there is a clear risk to others or if required by law (such as for notifiable diseases).

Balancing Doing Good and Avoiding Harm

Care workers must try to do good (beneficence) and avoid harm (non-maleficence). This balance is delicate in end of life care. High levels of pain medication may help comfort, but can raise concerns about hastening death.

Staff must follow guidance, seek medical advice, and document all actions.

Meeting Spiritual and Cultural Needs

People often have strong spiritual, religious or cultural needs at the end of life. Some wish for certain prayers or rituals, others may refuse some treatments. Staff must respect these wishes, but this can lead to:

• Difficulty if staff do not understand the beliefs
• Conflict with standard care procedures

Open discussion and learning will help meet these needs respectfully.

Family Involvement and Decision-Making

Family members often want to be involved in decisions. They may:

• Disagree with each other about best care for their loved one
• Expect staff to do more or less than is reasonable
• Have different beliefs and wishes from the person who is ill

These disagreements can lead to stress for staff and relatives. Care teams should include families where possible but must act in the best interests of the person receiving care.

Allocation of Resources

Sometimes, resources are limited. This could mean a lack of staff, medicine, or equipment. Workers may struggle with:

• Wanting to do more for everyone but lacking time or materials
• Making choices about who gets what sort of care

Following fair procedures and being open with all involved can help manage these pressures.

Types of Conflict that May Arise

Workers must deal with many possible conflicts linked to legal or ethical issues:

• Between a person’s wishes and those of their family
• Between personal or religious beliefs and professional responsibilities
• Among staff with different ethical views
• Between what is legally required and what feels right emotionally
• Over unclear or disputed advance decisions or DNACPR orders
• When resources or time are limited

Case Examples

These examples show how legal and ethical issues can become complicated in end of life care.

Advance Decisions Not Respected

Mrs Aziz wrote an advance decision stating she did not want artificial feeding if she became unable to eat. When she had a stroke, staff were unsure about withholding it. Her daughter wanted all efforts made to prolong life.

Staff had to check the advance decision was valid before following it, while supporting her family through the process.

Refusing Treatment

Mr Jones, living in a care home, chose to stop dialysis. His family disagreed, believing he did not understand the consequences.

An assessment under the Mental Capacity Act showed he understood his choice. Workers respected his decision, but supported family members through their distress.

DNACPR Disagreement

Mr Sidhu’s DNACPR order was in place, but his son wanted staff to attempt resuscitation following a cardiac arrest.

Staff followed the DNACPR as legally required but recorded all discussions and supported the family afterwards.

Cultural Wishes After Death

Miss Li’s family wanted certain prayers said immediately after her death but staff were unaware and started standard procedures.

Staff apologised and learned about this cultural practice so they could offer it for other families in future.

Approaches to Managing Conflict

There are ways to deal with legal and ethical disagreements in end of life care.

• Open and honest communication is key
• Involve the person as much as possible
• Hold regular family and team meetings
• Listen carefully to the needs and beliefs expressed
• Work closely with other professionals, including doctors, nurses and faith leaders
• Seek legal advice when unsure
• Use mediation or an independent advocate for disputes
• Always document actions and decisions clearly

Supporting Staff

End of life care is emotionally demanding. Conflicts and ethical dilemmas can affect staff wellbeing and confidence.

Organisations should offer:

• Support from experienced staff or managers
• Access to clinical supervision or reflective practice sessions
• Training on legal and ethical aspects of end of life care
• Information about advance decisions and the Mental Capacity Act

Final Thoughts

Dealing with death and dying brings legal, ethical and emotional challenges. These affect the person who is dying, their loved ones, and the care team. Working in health and social care, you will face these issues. Understanding the law and ethical principles helps you to make safe and respectful decisions.

Differences in beliefs, wishes and the law may lead to conflict. Listening, clear communication and good record-keeping are some of the strongest tools you can use. If in doubt, always ask for help. Supporting people at the end of life is a huge responsibility. By acting with compassion, integrity and openness, you will provide care that honours dignity and rights at this most significant time.