The Council of Europe (CoE) on Monday launched a guide to decision-making relating to medical treatment of end-of-life patients.

How people suffering from terminal or degenerative illnesses should be treated as they near the end of life is still a subject of controversy replete with moral dilemmas.

A particular instance cited in the guide is whether or not to use sedation to alleviate suffering, even though this could end up shortening the life of the patient.

The end-of-life is very often a moment of "high vulnerability" for the person concerned and their family, and the guide points out that this can have a profound impact on the patient's ability to exercise autonomy in decision-making.

Assessing a patient's actual ability to be involved in that decision making is one of the main issues that must be addressed. So the guide recommends that inquiring into patients' desires or previously expressed wishes is therefore an indispensable part of the decision 11making process, particularly among patients whose functional capacities have declined to such an extent that their ability to take part in the process is restricted.

This guide is aimed primarily at health care professionals, but it is also a source of information and a basis for discussion for patients, families and close friends. It proposes benchmarks relating both to principles that can be applied and the practices eventually carried out.

A CoE Committee of Ministers recommendation on the organization of palliative care has already alerted member states to the need to provide more information and training on the subject, and conduct research into various issues relating to the end-of-life.