healthcare update - issue 13
GMC guidance on treatment and care towards the end of life
On 19th May 2010, the GMC published new guidance on “Treatment
and Care towards the end of life”.
The guidance has attracted wide media coverage, with some
commentators apparently surprised that doctors should be required
to respect a competent patient’s wishes, even if that patient is
refusing life saving treatment. In reality, there is little new in
that, but the guidance is a timely reminder to clinical staff.
This article will look at the new guidance, however, what
remains clear is that established law, regarding the treatment of a
patient who is in the end stage of his or her life, has not
changed.
The new guidance
The new guidance will replace “Withholding and Withdrawing
life-prolonging treatments: Good practice in decision making”
published by the GMC in 2002.
Since that guidance was published, developments in case law and
legislation have occurred with Burke v GMC and the Mental
Capacity Act 2005 being the most notable. Doctors had also reported
a need for further advice on when cardiopulmonary resuscitation
should be attempted, particularly in respect of patients in
palliative and intensive care settings.
The new guidance reflects these developments and provides
detailed advice on the provision of care and treatment to patients
who are approaching the end of their life. It applies to competent
adults as well as adults who lack the capacity to make decisions
about their care. It also applies to young people, children and new
born infants.
The guidance does not apply to the sensitive issue of assisted
suicide and makes it clear that “decisions covering potentially
life-prolonging treatments must not be motivated by a desire to
bring about a patient’s death and must start with a presumption in
favour of prolonging life”.
Guidance on responding to patients’ requests for specific
treatment and dealing with resource constraints may be developed
and published in the future.
Legal support
The new guidance emphasises the importance of discussing a
patient’s end of life care with either the patient or their
relatives and carers if they lack capacity. However, situations
will always arise where relatives, and sometimes patients, disagree
with a doctor’s proposed treatment plan. Legal advice should always
be sought in those circumstances – we operate a 24 hour hotline for
clients in the event that urgent advice is required.
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The content of this update is provided for the purposes of
general interest and information. It contains only brief summaries
of aspects of the subject matter and does not provide comprehensive
statements of the law. It does not constitute legal advice and does
not provide a substitute for it.