ERCP in the elderly: more than just the age factor.

322 and family) of good end of life care. Currently the physician may ‘inadvertently fall into the trap of prognostic paralysis’ [1]. The clinical question ‘would I be surprised if this patient died within the next year’ has been advocated as a useful prompt for care planning, discussion with the patient and family, and in decision making [4]. COPD is a chronic incurable disease, and many patients with COPD will eventually die of their condition. Our current therapies, even when used, targeted and directed skilfully, cannot prevent this in every patient, and there will come a time for many when continued active care is intrusive and futile. The decision as to when this time has come is not purely a medical one and should be arrived at jointly by patient, family and physician (or multidisciplinary team). Nonetheless, accurate prognostic information is a vital element in informing this decision.