End of Life Care

Medical treatments should not be provided to patients:

  • where they are unlikely to provide benefit
  • where they have been refused by a competent patient
  • where there is a prior advance decision that is valid and applicable.

In practice these decisions and associated discussions may be very difficult for clinicians and distressing for patients and their families. Questions of what constitutes futility, the extent to which patients wishes should prevail over clinicians, and how far patients should be involved in decisions have all caused particular difficulty.

Recent guidance has emphasized that competent patients must be involved in decisions to withdraw care, or withhold lifesaving treatments such as CPR, even if attempts are likely to be futile. For patients who lack capacity, all decisions should be taken in the fullest sense of their best interest, and take into account any known views of the patient and their family. However the specific wishes of patients and families should not override the views of clinical teams where the risks, burdens and benefits of a treatment outweigh any likely benefit.  The goal should be to reach consensus with patients or their families as sensitively as possible, providing second opinions wherever practical, and using mediation services and legal advice if necessary. The courts may be required as a last resort.

Links to key resources are provided below to key guidance from the General Medical Council (GMC), The Resuscitation Council UK and British Medical association (BMA). Professional bodies such as the Intensive Care Society also provide further resources, as do the GMC and BMA. Other bodies such as medical defence organisations and ethics groups also provide useful information. 

 

Resources

  • ReSPECT - Recommended Summary Plan for Emergency Care and Treatment - ReSPECT is a process that creates personalised recommendations for a person’s clinical care in a future emergency in which they are unable to make or express choices. It provides health and care professionals responding to that emergency with a summary of recommendations to help them to make immediate decisions about that person’s care and treatment. ReSPECT can be complementary to a wider process of advance/anticipatory care planning.  
  • Fritz Zoë, Slowther Anne-Marie, Perkins Gavin D. Resuscitation policy should focus on the patient, not the decision. BMJ 2017;356:j813
  • Compassion in Dying - A UK charity that helps patients and their doctors draw up Advance Care Plans and other matters.
  • MyDecisions - An online tool for developing an advance decision and advance statement.

 

Other useful sources of information

Useful podcasts dealing with case specific situations:

Below is a link to an NHS Health Education England e-LfH e-learning module that deals with many of the issues addressed above:

 

 

 

 

 

 


*We have tried to find freely accessible resources on the practices and processes of the different religions around end of life care. We would be grateful for any additions to this section. If you know of any helpful open access resources in this area please contact us here

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