Regulating doctors, ensuring good medical practice

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.

Use the tabs below to

  • read the guidance;
  • see how the principles in the guidance apply in situations doctors often encounter or find hard to deal with;
  • read about how we developed the guidance.

You can also use the references page to find other organisations' supporting materials.

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.

 

Treatment and care towards the end of life

You can use the online version or the headings on the left to find the guidance you need quickly and easily.

You can navigate through the guidance page by page using the links at the foot of each page or browse for something more specific through the contents page, or open a pdf version of Treatment and care towards the end of life: good practice in decision making. (pdf)

back to menu

Supporting materials

e-learning session

A new e-learning session focusing on the General Medical Council’s (GMC) new guidance on treatment and care towards the end of life is now available to all doctors via e-ELCA (the e-learning programme commissioned by the Department of Health to support the national End of Life Care Strategy).

The session, Treatment and care towards the end of life: good practice in decision making, 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 on the e-learning for healthcare website.

Flow chart and vignettes

We have developed a flow chart that 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.  The vignettes and case studies included in these supporting materials highlight some of the key issues and principles covered in the guidance.

View the flowchart and its vignettes.

Video

A short video highlighting 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.

back to menu

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 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 (pdf).

back to menu

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).
back to menu

Background

Development of the guidance

You can read about the development of the guidance (1 mb, 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.

back to menu

Download the guidance