Hospital Dr News

“Improve care planning for end of life patients”

Patients must be given the opportunity to discuss what treatment and care they want towards the end of their life, new guidance says.

The GMC guidance emphasises to doctors the importance of listening to patients and recording an advance care plan to ensure the clinical team understand, and follow, the patient’s wishes.

It’s the first time the GMC has provided doctors with detailed direction on advance care planning for end of life treatment and is intended to help them lead the way in its improvement. The wishes of such patients are not always known by doctors, the clinical team and patients’ families, and this can lead to patients not getting the care they want.

A key principle of the document, called Treatment and care towards the end of life: good practice in decision making, is that doctors start from a presumption in favour of prolonging life and must not be motivated by a desire to bring about the patient’s death. 

However, there is no absolute obligation to prolong life irrespective of the consequences for the patient or their views.

Dignity and respect for the individual are also important themes in the guidance. Doctors are urged not to discriminate or rely on preconceptions of what kind of care particular groups of patients, such as the elderly or disabled, want towards the end of life.

The document also covers decisions involving premature babies and infants, doctors’ responsibilities after a patient has died and how they should approach conversations about organ and tissue donation. 

Dr Bob Taylor, paediatric intensive care consultant at the Royal Belfast Hospital for Sick Children and a member of the guidance working group, said: “Doctors often have to initiate the most difficult conversations at the most difficult time for the patients, their families and carers, yet these conversations are so important in reducing the distress and anxiety that are often felt as patients approach the end of life.

“I have seen first-hand the enormous benefits brought by doctors working closely with the patient, their family and carers, and the wider healthcare team through every stage of treatment and care.”

Dr David Vickers, registrar of the Royal College of Paediatrics and Child Health, commented: “The guidance places a welcome emphasis on the importance of recognising the rights of children and young people to be involved in these difficult decisions and underlines the importance of considering children’s views, however young they are.

“Paediatricians have a duty to safeguard and protect the health and well-being of children and young people by acting in their best interests. Parents and others close to the child also have this duty, so the emphasis on good communication between doctors, patients, families and the wider healthcare team in order to reduce conflict and disagreement is to be commended.”

Dr Stephanie Brown, director of policy at medical defence body MPS, added: “The legal and ethical environment in which doctors are delivering end of life care and treatment has changed and it is important that they are aware of, for example, the development in case law, the requirements of the Human Rights Act and the Director of Public Prosecution’s guidelines for prosecution over assisted suicide.

“The issues of end of life care and assisted suicide are intertwined, and although not within the remit of the GMC, the release of this guidance again highlights the need for greater clarity around the position for doctors facing difficult cases and requests from patients considering assisted suicide.”

The GMC considered 529 written responses to its consultation from a wide range of individuals and organisations, as well as more than 600 individuals who attended consultation events.

Read the full guidance here.

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