Editor – Randall and Downie assert that we did not respond to four of their criticisms. Taking them in turn:
There is a valid debate to have on the availability of intensive care beds, but deliberations on the prioritisation of their use must include consideration of the best interests of every patient under their care.
We agree that increased information is important in facilitating decision making at the end of life.
Regarding place of death, there is no contradiction with previous NICE guidance. The patients we are referring to are likely to be admitted through the accident and emergency department and are unlikely to have a choice about place of death. If there has been a chance to determine the preferred place of death, this of course should be taken into account.
The guidance recommends that doctors should, when speaking to those close to a patient, discuss that donation is a usual part of end-of-life care. Given that almost 20 million people or one-third of the total UK population are on the organ donation register, this is an appropriate recommendation to make. It is not suggesting that donation occurs in all, or even most, cases. Rather that it is a usual part of the end-of-life care to consider whether organ donation is appropriate.
Finally, it is not at all clear to us how medical intervention in a patient's best interests could interfere with the patient's rights under Article 3 of the European Convention on Human Rights. We understand that Randall and Downie might dispute that such intervention would be in the patient's best interests, but this is a different point. We would note further that this is not an issue raised during the extensive consultation and consideration of the draft guidance.