Learning materials

End of life care

Treatment and care towards the end of life: good practice in decision making sets out the ethical principles underpinning good end of life care, and provides advice to support doctors in approaching these often complex and difficult situations.

You can learn more through the case studies and flowchart, which illustrate how some of the important principles can be applied in practice, an e-learning session, and a short introductory video.

Case studies

Case study 1 explores the situation of 42 year old man diagnosed with prostate cancer, and the patient’s care team explore the likely benefits, burdens and risks of CPR for the patient.

Case study 2 explores the situation of an 82 year old man who has an increasing difficulty in swallowing food. The patient’s daughters want to care for him at home and the doctor considers the practicalities of clinically assisted nutrition and hydration.

GMP in Action

Good Medical Practice in Action (GMP in Action) also has a number of interactive cases studies related to end of life care issues:

	Doctor Ellis and his patient discuss whether to attempt CPR in the case of heart failure; and
	Mr Hartley's children disagree about withdrawing treatment for his abdominal cancer.

Flowchart and vignettes

The interactive flowchart sets out the decision making process where questions arise about a patient’s capacity to make their own decisions. We have also produced five short vignettes, which illustrate key points in the flowchart.

In one of the vignettes, we explore the situation of Mr Wu, who is 73 years old and was diagnosed 18 months ago with pulmonary fibrosis, after developing a dry cough and breathlessness.

Despite oxygen treatment, Mr Wu’s condition continued to deteriorate and over subsequent months he required 3 hospital admissions. The vignette explores the decisions taken by a variety of doctors involved in Mr Wu’s care and the discussions undertaken with Mr Wu and his wife about caring for him at home for the remainder of his life.

The remaining four vignettes explore:

• Providing additional support to enable patients to make and communicate their decision;
• Advance decisions to refuse treatment (ADRT) and their applicability in certain circumstances;
• Powers of Attorney; and 
• Doctors seeking information about the patient’s wishes, preferences, feelings, beliefs and values.

 

e-learning session

This e-learning session on End of life care is available to all doctors and explains the key principles in the guidance and helps doctors to apply the principles in the guidance to some of the common challenges that arise when caring for patients towards the end of life. Doctors can log in to complete the session using their GMC number.

Video

You can also watch a short video highlighting the main issues covered in the guidance and including clips from doctors, other healthcare professionals, a hospital chaplain and a patient, on the most important factors in ensuring patients receive good treatment and care towards the end of life.

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Confidentiality

Confidentiality sets out the principles of confidentiality and respect for patients’ privacy that doctors are expected to understand and follow. Seven pieces of supplementary guidance explain how the principles apply in some situations including reporting gunshot and knife wounds, responding to criticism in the press and disclosing information for education and training purposes.

You can learn more through the case studies, a PowerPoint presentation and a podcast on reporting gunshot and knife wounds.

Case studies

These case studies highlight and explore some of the principles covered in Confidentiality and its supplementary guidance.

• Elder abuse – what should Dr Rix do when his elderly patient tells him, in the strictest confidence, that her daughter and carer has hit her?
• Serious communicable diseases – what should Dr Biggs do when his patient says he does not want his GP, and later his surgeon, to be told of his HIV diagnosis?
• Vulnerable adults – what should Dr Praed do when he learns that a young patient with learning disabilities is falling into bad company and neglecting his diabetes?
• Alcoholic colleague – Dr Okonkwo is a GP whose patient is a physician with an alcohol problem. Should Dr Okonkwo raise a concern about her patient’s fitness to practise?
• Sex offender – Dr Hosta is a psychiatrist treating a sex offender who she thinks might not register with the police. Should Dr Hosta report her concerns to the police or prison service?
• Deceased patient – Dr Kaur receives a letter from solicitors acting for a deceased patient’s widower, asking for copies her medical records; but they contain details of a termination from before their marriage as well as information about her mental health provided by the patient’s daughter. Should she disclose?
• Reporting crime – Dr O’Hara is a doctor in a drug addiction clinic. Her mobile phone is stolen and she has good reason to believe it was one of six patients. Should she report the theft to the police, even if it involves identifying the patients, without being sure which of them stole the phone?

GMP in Action

Good Medical Practice in Action (GMP in Action) also has a number of interactive cases studies related to confidentiality issues:

	Dr Peters' patient is unaware of his partner's positive HIV status;
	Dr Williams' patient has concerns about his wife’s fitness to drive;
	Dr MacDonald’s patient arrives at A&E with a knife wound; and
	Dr Gallagher’s patient presents with signs of domestic violence.

Presentation

This PowerPoint presentation provides some historical, ethical and legal context to the guidance, including an explanation of why confidentiality is seen as such a fundamental professional value.

It highlights what's new in the guidance and some of the confidentiality questions most frequently asked by doctors and patients.

Please feel free to use it in your own teaching and training.

Please note: To view the additional notes in the presentation, you will need to save it to your computer and open the presentation from there.

Podcast

Listen to a podcast on reporting gunshot and knife wounds:

• Download a transcript of the podcast (23kb, pdf)
• Download the podcast (7 MB, mp3)

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GMP in Action

Good Medical Practice in Action (GMP in Action) is set of interactive scenarios in which the user can follow a patient on his or her journey and choose what the doctor should do at crucial points in the process.

The case studies below have been developed over a number of years and highlight the issues which doctors most frequently have to address in their interactions with patients. For example, in this case study, Clementine’s father, who is 76, underwent a gastrectomy and chemotherapy six months ago to treat a malignant stomach cancer. He has also been diagnosed with Alzheimer’s and his condition has declined significantly over the past year. Clementine and her brother Robert have different views about the treatment of their father …

Other case studies include:

	Adrian goes to a sexual health clinic where Dr Peters realises that Adrian’s partner has not told Adrian that she is HIV positive. Should Dr Peters disclose this information to Adrian? Decide what Dr Peters should do.
	An elderly patient, approaching the end of her life, requests to be treated at home. The care team discuss involving the patient and her family in the decision about attempting CPR. Decide what the doctor should do.
	Mr Jessop shares concerns about his wife’s fitness to drive with their GP, Dr Williams. Should Dr Williams inform the DVLA? And should she tell Mrs Jessop the source of her concerns? Decide what Dr Williams should do.
	A 15 year old comes into the GP surgery for advice about contraception. Her parents are unaware of her visit. Decide what Dr Williams should do.
	A young man is brought to A&E with what looks like a stab wound. Should Dr MacDonald tell the police? What should she say when there is criticism of the case in the local press? Decide what Dr MacDonald should do.
	A deaf woman, whose preferred language is British Sign Language, requires an invasive procedure. The doctors require consent for the procedure but there is no interpreter available. Decide what the doctors should do.
	A woman attends A&E with injuries resulting from domestic violence, but does not want the police involved. Decide what Dr Gallagher should do.

To explore all the interactive case studies, view Good Medical Practice in Action.

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Students in Action

Medical students: Professional values in Action is an interactive website aimed at medical students and medical school fitness to practise decision makers.

You can test your knowledge of our guidance Medical students: professional values and fitness to practise through several quiz questions, ‘spot the mistake’ cartoon strips and four case studies. In the case studies, you take on the role of either a medical student or the medical school and face a variety of challenging scenarios encountered on clinical placements or at medical school.

For example, you can play the role of Beverly, an educational tutor mentoring a mature student. Lately, Jeff, the medical student has become withdrawn and his grades are beginning to slip. Beverly organises a meeting to discuss his progress and find out what is wrong and learns that he is finding it difficult to balance his study with the demands of home and work. Decide what Beverly should do next…

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