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

About this guidance

The General Medical Council (GMC) is the statutory regulator for the medical profession in the UK, and this guidance applies to doctors working in all four UK countries.

This guidance is based on long-established ethical principles, which include doctors’ obligations to show respect for human life; to protect the health of patients; to treat patients with respect and dignity; and to make the care of their patients their first concern. It expands on the principles of good practice in the GMC’s Good medical practice (2013) and Consent: patients and doctors making decisions together (2008), and replaces the booklet Withholding and Withdrawing Life-Prolonging Treatments (2002).

This guidance takes account of, and is consistent with, current law across the UK, including the laws on decision making for patients who lack capacity (the Adults with Incapacity (Scotland) Act 2000 and the Mental Capacity Act 2005); the law prohibiting killing (including euthanasia) and assisting suicide; and the requirements of the Human Rights Act 1998. However, it is not intended as a statement of the legal principles or a substitute for legal advice. Doctors must seek up-to-date advice when there is uncertainty about how a particular decision might be viewed in law, in the jurisdiction in which they practise.

This guidance is addressed to doctors. However, it may also help patients and the public to understand what to expect of their doctors, in circumstances in which patients and those close to them may be particularly vulnerable and in need of support. Other members of the healthcare team may also benefit from it, given their crucial role in delivering end of life care.

How this guidance applies to you

In this guidance the terms ‘you must’ and ‘you should’ are used in the following ways:

  • ‘you must’ is used for an overriding duty or principle
  • ‘you should’ is used when we are providing an explanation of how you will meet the overriding duty
  • ‘you should’ is also used where the duty or principle will not apply in all situations or circumstances, or where there are factors outside your control that affect whether or how you can follow the guidance

The footnotes, references, endnotes and legal annex are intended only to give information that may be helpful additional background. References to publications by other organisations are intended only as examples of available national resources.

This guidance is not, and cannot be, exhaustive. So you should use your own judgement to apply the principles it sets out to the situations you face in your own practice.

Serious or persistent failure to follow this guidance will put your registration at risk. You must, therefore, be prepared to explain and justify your actions.