Terminally ill patients get final say on when and how they may die

Published on Wednesday 19 May 2010 23:34

PATIENTS who are terminally ill should, when the risks and benefits of treatment are finely balanced, have the final say on their care, according to new guidance for doctors.

And people who wish to die quickly can ask ahead of time for food and fluids to be withdrawn, the document says.

While medics will not be expected to provide treatments which have no clinical benefit or that could do harm, they must pay attention to a patient's wishes, according to the General Medical Council.

The report follows guidance from the Scottish Government, which mean that paramedics, GPs and hospital doctors will be stopped from reviving terminally ill patients whose hearts stop, should they have expressed a wish not to be resuscitated.

The new GMC guidance was yesterday welcomed by doctors and health campaigners.

Margo MacDonald, MSP, who is campaigning for legislation on assisted suicide, said the guidance was a little "confused" and stressed that patients' views must be at the centre of decisions made about their care.

The GMC guidance sets out the actions doctors should take when requests for treatment are made by patients approaching the end of their lives. "When the benefits, burdens and risks are finely balanced, the patient's request will usually be the deciding factor," the guidance says.

However, doctors still have the final say, and can withdraw treatments that are doing no good.

The guidance encourages doctors to discuss plans with patients and their families ahead of time, particularly for people who are not expected to live beyond another year.

It says doctors must start from a presumption that life should be prolonged and "must not be motivated by a desire to bring about the patient's death".

The guidance stops short of discussing assisted suicide, which is illegal in the UK and is the source of ongoing debate and controversy.

The guidance is an update of a similar document published in 2002, taking into account new legislation surrounding mental capacity and human rights, and advances in treatment.

Niall Dickson, chief executive of the GMC, said: "This is one of the most challenging areas of practice and both doctors and patients have told us that good care needs good communication."

Ms MacDonald said she welcomed the attention being given to end-of-life issues. However, she stressed the importance of decisions being made by patients, rather than their families.

"If there's any room for coercion or malign intent, it comes through the families or any other person," the independent MSP said. "I think these guidelines are a bit confused with the idea of patient autonomy and the role of the family and the doctor.

"I want the onus to be on the patient."

A spokeswoman for the Scottish Government said: "We welcome the new General Medical Council guidance, which will provide a useful framework for health and social care professionals when providing care for patients with palliative and end-of-life care needs."

GMC ADVICE

THESE are some of the guidelines set out in the new GMC document.

&#149 You must give patients who are approaching the end of their life the same quality of care as all other patients.

&#149 Decisions concerning potentially life-prolonging treatment must not be motivated by a desire to bring about the patient's death.

&#149 There is no absolute obligation to prolong life irrespective of the consequences for the patient, and irrespective of the patient's views.