End of Life Care
The GMC guidance Treatment and care towards the end of life: good practice in decision making replaces the guidance " Withholding and withdrawing life-prolonging treatments: (2002) " and expands on the guidance in "Seeking patients' consent: the ethical considerations (1998)" and that contained in "Good Medical Practice"
The GMC Decision making and consent sets out the principles on which good clinical decisions should be based and provides a framework for good practice when providing treatment and care for patients who are reaching the end of their lives.
It lists seven principles of decision making and consent.
Doctors now have to be satisfied that they have consent from a patient, or other valid authority, before undertaking any examination or investigation, providing treatment, or involving patients in teaching and research.
The guidance concentrates on decision-making in the context of investigations or treatment; but the principles apply more widely, including:
- decisions on taking part in research
- decisions at the end of life
The guidance emphasises the need for open and honest conversations between doctors, people approaching the end of life and those close to them. The guidance also urges doctors to:
- make a record of discussions with patients about future care, as well as the decisions made
- review Advance Care Plans and update these as the patient's situation or views change
- identify patients for whom advanced care planning might be appropriate.
It does not cover doctors' responsibilities to protect or disclose personal information about patients. See Confidentiality (2017) for further information on this.
As the law relating to decision-making and consent, particularly for patients who lack capacity, varies across the UK, doctors need to understand the law as it applies.
Making decisions about treatment and care for patients who lack capacity is governed in England and Wales by the Mental Capacity Act 2005. The legislation sets out the criteria and procedures to be followed in making decisions when patients lack capacity to make these decisions for themselves. It also grants legal authority to certain people to make decisions on behalf of patients who lack capacity.
It is important that you keep up to date with, and comply with, the laws and codes of practice that apply where you work. The legal framework (paragraphs 77-80) to Decision making and consent gives more detail about relevant common law and legislation, and links to further information. If you are unsure about how the law applies in a particular situation, you should consult your defence body or professional association, or seek independent legal advice.
So what do you need to do now?
- You should start to identify who these patients are, and how to have a sensitive conversation with them about their future care. You may also like to take a look at Find Your 1% : supporting GPs in delivering quality end of life care
- You should work with the patient concerned or where appropriate, their relatives or advocate to ensure they are treated fairly with dignity and without prejudice.
The GMC has warned that serious or persistent failure to follow the guidance could put the doctor's registration at risk
You may also find our section on Advanced Decisions and Care Planning useful.