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Treatment and care towards the end of life: good practice in decision making

About the guidance

This guidance provides a framework for good practice when providing treatment and care for patients who are reaching the end of their lives.

It expands on the guidance in Consent, patients and doctors making decisions together, which sets out the principles on which good clinical decisions should be based.

Read the guidance

The guidance in practice

In the tabs below you can find a range of learning resources to support you in applying the guidance to your practice, plus information about how we created the guidance and our role in the Leadership Alliance for the Care of Dying People.

You can find new resources to support you in our end of life care campaign and also find links to a range of external resources that provide help and advice about different aspects of end of life care.

Mental capacity decision support tool

If you are in doubt about your patient’s capacity to make a healthcare decision, our interactive tool will help by identifying the steps you need to take: first to assess capacity and then, if your patient lacks capacity, to make a decision about how to proceed. The information takes account of capacity legislation across the UK as of May 2016.

It draws on the principles in our guidance Consent: patients and doctors making decisions together and Treatment and care towards the end of life: good practice in decision making and includes a number of case studies at each stage of the decision-making process to show how the guidance applies in practice. As well as the case studies you can download relevant guidance, a flowchart and a ‘Reflections Record’ for noting your thoughts about the tool and how you use it, so you can reflect on your practice. back to menu

Learning materials

e-learning session

This e-learning session focuses on our guidance on treatment and care towards the end of life.

The session explains the key principles in the guidance and helps you to apply them to some of the common challenges that arise when caring for patients towards the end of life. You can log in to complete the session using your GMC number on the e-learning for healthcare website.

Explore the mental capacity decision support tool

The tool draws on the principles in our guidance Consent: patients and doctors making decisions together and Treatment and care towards the end of life. It includes a case study at each stage of the decision-making process to show how our guidance applies to the clinical situations you may face. The tool also features a range of downloadable resources, such as relevant guidance, a flowchart setting out all the steps in the tool, case studies, and a record to help you reflect on your skills and understanding. 

End of life care video

This short video highlights the main issues covered in the guidance and including short 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.

View the end of life care video.

GMP in action

GMP in action is an interactive web section which brings the GMC's ethical guidance to life.

You get to choose what the doctor should do in a series of case studies highlighting how the principles in our guidance might work in practice.

The following case studies explore issues covered in Treatment and care towards the end of life: good practice in decision-making.

Mrs Conti. Mrs Conti has heart failure, her prognosis is very poor and she wishes to be discharged home. The clinical team think that CPR should not be attempted if Mrs Conti's heart stops. How should they approach this discussion with her and her family? Decide what the doctor should do.    
Mr Hartley and his daughter Clementine. Mr Hartley has had treatment for abdominal cancer but his condition is deteriorating and he is refusing further surgery. There is disagreement between his adult children, Clementine and Robert, about whether to continue with active treatment. Should the doctors accept Mr Hartley's refusal? And what can they do to help resolve the conflict within the family? Decide what the doctors should do.  

Please note

The vignettes and case studies are fictional and for illustration purposes only.

They provide examples of how the decision-making model in the guidance might work in practice.

Neither the flow chart nor associated material represent GMC guidance or policy in themselves, nor are they intended to replace Treatment and care towards the end of life: good practice in decision making (2010) or any other GMC guidance.

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Additional explanatory guidance

When a patient seeks advice or information about assistance to die

When we consulted on guidance for decision-makers in 2012 a number of doctors asked how they should respond to patients who asked for advice or help in ending their lives. Doctors were concerned that patients should not feel abandoned by them at this most difficult time – but were concerned that discussions could lead to them breaking the law.

This short explanatory guidance has been written in response to this concern. It provides advice on how the principles in Good Medical Practice and Treatment and care towards the end of life: good practice in decision making (pdf) apply when patients who are reaching the end of their life, or who have severe disabilities, seek help or advice about ending their lives.

Read the guidance When a patient seeks advice or information about assistance to die.

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Case studies

Case studies

We have developed two longer case studies on cardiopulmonary resuscitation (CPR) and clinically assisted nutrition and hydration (CANH), issues that we know can be particularly difficult for doctors, members of the healthcare team, patients and those close to them:

  • Case study 1 - explores issues arising from decisions about cardiopulmonary resuscitation (CPR)
  • Case study 2 - explores issues arising from clinically assisted nutrition and hydration (CANH).
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Background

Development of the guidance

You can read about the development of the guidance (pdf) which explains the process we undertook during the review.

This included an initial consultation on issues for the guidance to cover and a wide-ranging public consultation held from March to July 2009 to test the draft guidance.

Leadership Alliance for the Care of Dying People

We have been a member of the Leadership Alliance for the Care of Dying People (LACDP), a group of organisations which came together to lead and provide a focus for improving the care of dying people and their families, following the review of the Liverpool Care Pathway. Find out more about the priorities for care which the Alliance has produced to help doctors and other healthcare professionals.

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Download the guidance