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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:

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:

Articles on Tissue donation (South Central SHA) and Donating a Body to Medical Research.

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?

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.


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Updated on Friday, 21 May 2021 1599 views