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Dementia is the leading cause of death in England and Wales. Since the publication of the Dementia Strategy in 2009, there has been an increasing emphasis on advance care planning, with the aim of empowering people with dementia to express their wishes before mental capacity is lost, promoting a 'good death' and enabling them to 'die well'. This literature review of end-of-life care for people with dementia in UK care homes shows that dementia is still not widely regarded as a terminal condition, and that residents of care homes sometimes face unnecessary admissions to hospital in the dying phase. People with dementia at the end of their lives are still not accessing appropriate and timely palliative care, and advance care planning is still not part of routine dementia care despite the evidence and recommendations. This denies them the known benefits of reduced patient and carer distress, reduced hospital admissions and inappropriate treatments, the upholding of person-centred care principles, decision-making, and ensuring that people with dementia can expect a 'good death'. [ABSTRACT FROM AUTHOR]

The article examines the policy and practice interface in Great Britain on the issues of law, ethics and end-of-life care. Topics covered include how palliative care aims to provide support to people with advancing, incurable somatic illness, the moral impact of criminalisation, and examples of practice informing law and policy.

The article reports on the surgical and pharmaceutical treatments that are available for older people who are near the ends of their lives and are suffering from pain caused by arthritis. A discussion of the moral and ethical issues which are raised when deciding whether to treat arthritis in terminally ill patients is presented. The end of life care strategy, which is a tool which can be used by medical professionals when considering how to support people with advanced disease, is discussed.