GMC launches consultation on End of Life Care

Call to doctors and patients for their views on how difficult decisions on end of life care should be made.

The General Medical Council is asking doctors and patients for their views on how difficult decisions on end of life care should be made.

The new draft guidance “End of life treatment and care: good practice in decision making” seeks to help doctors provide good care by responding to individual’s clinical, emotional and psychological needs. This includes making decisions about when treatments may become too burdensome in relation to the benefits they bring.

The draft guidance is clear that “decisions concerning life-prolonging treatment must not be motivated by a desire to bring about the patients’ death, and must start from a presumption in favour of prolonging life.” The draft guidance is not about assisted suicide or euthanasia but about ensuring that all doctors know how to treat patients at the end of life and within UK law.

The consultation asks for views on several areas including:

• Cardiopulmonary resuscitation (CPR) – The draft guidance includes advice on when discussions about CPR are appropriate and how to approach these difficult conversations with patients, their families and carers.  
   
• Clinically assisted nutrition and hydration – The draft guidance includes more information about the clinical complexities and takes account of the special status that clinically assisted nutrition and hydration has for many people.
  
• Advance care planning – the draft guidance includes more detail on palliative care, including: how doctors should deal with requests and refusals for life prolonging treatment; and how to approach discussions about future care with patients and their families including advance requests or refusals of treatment.
   
• Care after death and organ donation – A new section in the draft guidance covers a range of issues, including: taking account of cultural and religious considerations; dignity and respect for the body; responsibilities towards families, carers and others close to the patient; and when it might be appropriate to discuss organ donation with patients or their families.
   
• Neonates, children and young people – The guidance recognises that emotionally demanding decisions may have to be made, for example about when to resuscitate an extremely premature baby. The draft guidance makes it clear that a doctor’s primary duty is to the child patient and any decision taken must be in their best interest.  

Lady Christine Eames, Chair of the working group responsible for drafting the guidance said: “Good end of life care helps patients to live as well as possible until they die and to die with dignity. The draft guidance is based on long-established ethical principles which include doctors’ obligations to show respect for human life; protect the health of their patients; and to make the care of their patients their first concern”

“This is an important piece of guidance which will assist doctors to continue to provide high quality care to patients in the final stage of life.

”The working group members reflected a diversity of religious and patient perspectives as well as legal and clinical views from across the UK. Their hard work and commitment to developing this draft guidance has been much appreciated and I would encourage people to share their views with us.”

Jane O’Brien GMC Assistant Director of Standards and Fitness to Practise said: “Treating patients at the end of their life raises many difficult ethical questions for doctors. 

“Our guidance aims to ensure that all doctors are aware of the ethical and legal principles that should underpin practice in end of life care and to let patients know what they can expect from their doctor.

“While the end of life consultation touches on many emotionally charged subjects, this is not a debate about assisted suicide. Our guidance to doctors on this matter will always remain with the parameters of the law.”

Dr Dominic Bell a Consultant in Intensive Care at the General Royal Infirmary in Leeds said:

“If the medical profession is to maintain public trust, both patients and their next of kin must be confident that those who share or understand the patients values and belief at this most vulnerable stage of their lives will be listened to and their views respected. Finding the correct balance may be challenging at times, but should be achievable with empathy, high standards of communication, and patience.”