Caring for patients who are approaching the end of life is an important part of the paramedic's role. Patients' circumstances are individual; for some, death is expected and may even a welcome (albeit sad) relief from a long period of pain and distress, while for others it is a tragic, unexpected outcome after every effort to prevent it has been exhausted. Regardless of circumstances, paramedics have to make wide-ranging clinical decisions, underpinned by a complex legal and regulatory framework. Paramedics generally have to obtain a patient's informed consent before proceeding with any intervention. They may be challenged if a dying patient refuses life-sustaining treatment or no longer has the mental capacity to consent and need to know the law on decision-making in these cases. This article discusses issues around capacity and consent at the end of life. The next article in this series considers issues such as advance decisions to refuse treatment and do not attempt CPR decisions.