When a patient is unwell and will ultimately die of a condition that is progressing, a Ceiling of Care should be established. This means that doctors should engage with the patient, those close to them and the healthcare team in order to determine what level of treatment is appropriate to give to a specific patient towards the end of their life.
Some treatment are commonly limited, in order to not cause unnecessary or pointless harm. These commonly include deciding not to give CPR, limiting what ventilation may be given (e.g. non-invasive, invasive or none), and limiting life-prolonging drugs (e.g. antibiotics). In addition, the decision not to provide artificial nutrition (e.g. via PEG tube) may be taken.
However, some treatments or parts of care cannot be limited by a Ceiling of Care plan. These include treatments that are not designed to prolong life, but to ensure the patient is comfortable and retains dignity in their death. For example: analgesia (painkillers), offering general nutrition (food and drink), and basic personal care.
Ceilings of Care can be dynamic and are often less formally documented then Advanced Decisions (which are legally binding). It is important to note that a decision to limit CPR as part of a Ceiling of Care does not hold the same legal significance as a formal DNACPR decision.