Letter: End-of-life care

Making decisions at the end of life can be an extremely complex and difficult process, as MSP Margo MacDonald's comments highlighted (your report, 20 May).

Thanks to a two-year development process through which hundreds of individuals and organisations shared with us their experiences of end-of-life care, we have been able to produce guidance for doctors to help them work within an ethical and legal framework.

Our guidance makes it clear that the patient, family, doctor and healthcare team all have a role to play in making decisions, although once the patient understands the options available, they make the final decision on what treatments they want.

If a patient doesn't have capacity to make the decision, for example if they are unconscious, the doctor must work closely with the family to work out what would be of overall benefit to the patient, taking into account the patient's values and beliefs.

To help ensure patients receive good care, in line with their wishes, the guidance emphasises the importance of really listening and being open and honest about the options and treatments available.

JANE O'BRIEN

Assistant director of standards and ethics

General Medical Council

London