Advance planning urged for dying
Thursday May 20th, 2010
British doctors need to encourage patients to agree in advance the kind of treatment and care they expect if they suffer a terminal illness, according to guidelines published yesterday.
The new General Medical Council guidance is meant to help doctors as patients increasingly seek to set out if they want their life to end fast.
According
to the GMC, there is no "absolute obligation" to prolong life
if a patient does not want treatment or might suffer unacceptably. But
a doctor must presume at the outset they will be seeking to keep a patient
alive.
One medical organisation said yesterday it was facing growing numbers of inquiries from doctors seeking advice on living wills and other instructions from patients and their families.
The GMC said doctors should listen to patients from the outset and record an advance care plan if possible to ensure their wishes were understood.
GMC chief executive Niall Dickson 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. That means listening to patients and families, creating opportunities for them to talk about the care they want before death, and explaining the options.
"Often this is not easy especially when patients are moved to a different setting, when care is provided during the night or at weekends, when doctors are under pressure or where there are language barriers."
Dr Bob Taylor, an intensive care specialist at the Royal Belfast Hospital for Sick Children, Northern Ireland, said: "Doctors often have to initiate the most difficult conversations at the most difficult time for the patients, their families and carers, yet these conversations are so important in reducing the distress and anxiety that are often felt as patients approach the end of life."
And kidney patient Jonathan Hope also backed the guidelines.
He said: "I have had 25 years of kidney failure and in that journey I have faced death, seen fellow patients die, observed the difference between a good and a bad death and cared for the dying. Much of the care has been exceptional, however, I believe it would be easier for us each to receive the end of life care we would like if, as doctors and patients, we were more open about dying."
GP Dr Mayur Lakhani, chair of the National Council for Palliative Care and the Dying Matters Coalition, also backed the guidance.
He said: "Doctors have a responsibility to become familiar with their duties to people approaching the end of life - as set out in this document. Discussing and making plans in advance with people about where they want to be cared for, or to identify what their priorities for care are is essential."
The Medical Defence Union said it had recently fielded dozens of queries from doctors about patient decisions to refuse treatment or family requests to withdraw treatment. Often doctors wanted to know how to judge whether a patient was capable of making the decision.
The MDU said the GMC now required doctors to consider "overall benefit" rather than "best interests".
Dr Emma Cuzner, of the MDU, said: In our experience, most doctors approach end-of-life care with great sensitivity but it is important that there is support and advice available to help them communicate with patients and families and resolve any disagreements about a patient's care and treatment."
The British Medical Association offered further backing for the guidance.
Dr Tony Calland, chair of the BMA medical ethics committee, said: "How best to care for individuals at the end of life is one of the most complex areas in medicine and it is essential that clear guidance is in place to assist doctors to act in the best interests of their patients."
Tags: General Health | Nursing & Midwifery | UK News
Printer friendly page