We thank Dr Waite for alerting readers to further useful guidance on advanced care planning. While we agree that there is much to be done from the 2009 Royal College of Physicians report, we have chosen to address the aspects of Mrs S's end-of-life care. In particular, we have focused on the synergies between the psychiatric staff and the local hospice.
On one particular point we stated that people can express their wishes about preferred place of treatment in an advance decision. However, we never stated that an advance decision is always binding – on the contrary, we said that Mrs S's was invalid.
The debate raised around Burke v GMC is around providing treatment not in a patient's best interests and is not directly relevant to our paper.
However, Dr Waite's final broader point that ‘ascertaining how patients would like to be treated when they are unable to make decisions for themselves should be part of routine practice with all psychiatric patients’ is welcomed.
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