End of life care: helping doctors get it right

With a review of the Liverpool Care Pathway being announced amid reports of poor care and lack of consent, end of life care is back in the spotlight.

End of life care is one of the most challenging areas of medical practice. As well as being highly sensitive and often emotional for those involved, doctors working in this area have to navigate complex ethical and legal frameworks.

Our guidance, Treatment and care towards the end of life: good practice in decision-making, is designed to help you tackle the big challenges in end of life care, and to make sure you are working within the law.

'The end of life is a distressing time for the patient and their relatives,’ said Professor Sir Peter Rubin, Chair of the GMC.  

‘Doctors and patients should make decisions together about the treatment and care that will meet patients' wishes and needs in the last days or hours of their lives. Clear and sympathetic communication by doctors is essential and our guidance gives helpful advice on this to doctors.’  

What’s in the guidance?

• Two decision models give you a step-by-step illustration of who decides and who should be consulted about treatment.
  • One model covers patients able to make choices about end of life care.
  • One model covers patients who lack capacity to make their own choices, and includes the legal requirements across the UK.   
• Guidance on the role of families, independent advocates and team members in supporting a patient to make decisions, or to make decisions when patients are unable to decide for themselves.
• Guidance on advance care planning:
  • what to discuss
  • where to get help with these difficult conversations eg chaplaincy services
  • the role of healthcare attorneys in making decisions
  • how to deal with advance refusals of treatment - written or oral statements.  
• Guidance on dealing with clinical uncertainties, emotional distress, and disagreements about what may be of overall benefit to a patient who can not make their own decisions.
• Guidance on nutrition and hydration, including by drip and tube, stressing the importance of:
  • explaining the clinical complexities to patients and family members
  • monitoring and reviewing the patient’s condition to ensure they remain comfortable and free from distressing symptoms
  • extra safeguards to be followed when decisions involve a patient in the last weeks and days of life.
• Guidance on cardiopulmonary resuscitation including:
  • when to talk about DNACPR with patients and/or their family and carers
  • what to explain
  • making a DNACPR
  • role of the doctor/team, patient and family  
• Guidance on care after death: doctors’ responsibilities to the family after a patient dies.               

Learning materials

In addition to the guidance, we have also produced learning materials on end of life care including:

• an e-learning module with NHS e-Learning for Healthcare
• case studies
• flow charts
• a video.  

You can read the guidance and find all of these resources on our end of life care web pages.