Mr. Peter Tyndall:

There probably is as it is a very sensitive area. Ultimately, it should be a clinical decision and there should be full communication with the patient and the family if requested. It would be preferable for that to happen. People do not understand that it takes pressure from both the individual and the family if there is a realisation that the decision would be primarily clinical. There is the possibility that people would feel disengaged from the process as a consequence and there is a need to improve guidance. It is a difficult area and sometimes it is clear that to be involved in very invasive efforts to save a person's life is not appropriate when practically there is no prospect of extending the life or where quality of life would be significantly damaged by the condition and intervention. Explaining this to individuals and ensuring not only that guidance is right, but that communication is appropriate, can be challenging. There is more work to be done.