Doctors are ordered to take more notice of dying patients' last wishes

Published on Monday 2 March 2009 21:20

THE wishes of dying patients are to be given more weight under new guidance to be issued to doctors.

In cases where patients demand that treatments such as artificial feeding and hydration are given to them until death, doctors will be told they should carefully consider the harm that might be caused by going against these wishes.

But the guidance, produced by the General Medical Council, stops short of telling doctors they must always provide treatment requested by patients and their families in cases where continuing this kind of care could do more harm than good.

The detailed advice, a consultation on which will start later this month, follows controversial cases where patients have challenged the medical profession in efforts to make sure they continue to get treatment even when they lose the capacity to express their wishes.

In 2004, the GMC's previous guidance was judicially reviewed after Leslie Burke, a patient with a nervous system disorder, disputed medical advice for fear that his nutrition could be withdrawn.

Although he initially won the case, it was later overturned on appeal. But the GMC decided that its guidance did need to be updated given the complex nature of end-of-life decisions.

Jane O'Brien, from the GMC, said it was now responding to the criticisms of the previous guidance.

"We really wanted to allay people's fears that doctors will just be on their own agenda and won't be listening to patients, and to emphasise the importance for doctors of taking into account patients' wishes and going along with them wherever that is practical and reasonable.

"It does not change the position in law that ultimately when a patient has lost capacity, a doctor will make a decision unless the patient has left an advance refusal or has nominated someone to speak for them," she said.

"But it says that the responsibility for making that decision involves taking account very formally and seriously the wishes of the patient."

The guidance says that the most "difficult and sensitive" decisions in end-of-life care involve stopping or starting potentially life-prolonging treatments such as cardiopulmonary resuscitation (CPR) and nutrition and hydration.

It stresses that doctors must consider a patient's decision to refuse or request a treatment, taking into account the damage that may be caused by not doing so.

In the case of a patient's request for artificial feeding, the guidance says: "You should take this into account in deciding what course of action would be in their best interests, having regard to the harm that might be caused, on the one hand by going against the patient's wishes and on the other by continuing to provide clinically assisted nutrition or hydration."

Doctors who fail to follow GMC guidance risk being struck off. Dr Peter Terry, chairman of British Medical Association Scotland, said: "It's good medical practice for doctors to take account of patient views when advising on the most appropriate treatment in all situations."