| Sumario: | Both for reasons of patient autonomy and resource considerations, there is reason to look at how to improve the decision-making processes relating to the limitation of medical treatment at the end of life so that overtreatment can be avoided. Although part of the knowledge base for the conclusions in this report is weak, it appears that:1. Factors such as cultural, ethnic, religious and socio-economic factors in addition to diagnosis, marital status, age, gender and experience can contribute to decisions about medical treatment and care at the end of life and patients' needs for information and participation in decision-making.2. A majority of patients with severe disease states that they want to be informed about their disease and prognosis and discuss issues related to treatment and care in the terminal stage. Often this is not well enough cared for, and awareness of patients' preferences can be incomplete.3. Prognostic tools in addition to clinical assessment, knowledge of patient preferences, interdisciplinary teamwork, good communication skills and expertise in ethics and law may be helpful in the decision making process.4. A majority of those asked state that they want to die at home, but there are far fewer people who actually die at home.5. Using expertise in palliative (pain relief) medicine may cause fewer hospital admissions, shorter hospital stay, less use of high-tech treatment and a larger proportion who die at home among those who want it. Little is known about which organisational model for palliative treatment is the best.6. Advance Directives / declarations to abstain from medical treatment in certain situations, or the appointment of a proxy, can strengthen the patient's autonomy in making decisions about treatment limitation when the patient is unable to participate in decisions.7. A more continuous and comprehensive plan for the end of life where the patient's understanding of their prognosis, preferences, values and treatment goals are actively sought, seems to a larger extent to address the needs of those involved in decision-making, than the use of advance directives alone. An advance directive can be included in such a plan.8. There is little research evidence on these issues for children and young people.
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