Doctors told to give more respect to wishes of dying patients
General Medical Council to publish new guidelines for GPs on end-of-life care but stance on euthanasia remains unchanged.
Debbie Purdy, with husband Omar Puente, who lost her court of appeal bid to have the law on assisted suicide clarified.
Doctors will be told to place a greater weight on the wishes of dying patients when making decisions about their care under new guidelines from their professional regulator.
The General Medical Council (GMC) will publish draft guidance later this month advising doctors how to handle decisions about end-of-life care, including resuscitation and how they should deal with requests and refusals for life-prolonging treatment.
The advice covers all life-threatening conditions, including heart failure, brain damage, cancer, dementia, as well as patients in a permanent vegetative state.
However, it barely mentions euthanasia or assisted suicide, which remain illegal despite calls for a change in the law.
The draft advice states that it should not be seen as a substitute for the guidance on the law on assisted suicide that patients seeking to end their lives have recently tried to obtain.
Debbie Purdy, who has multiple sclerosis, last month lost a court of appeal bid to make the director of public prosecutions provide guidance on the circumstances in which family members could face prosecution for assisted suicide.
Jane O'Brien, assistant director of standards and ethics at the GMC, said doctors still had the final say on what treatment they considered to be in their patients' best interests.
But she added: "We are asking them to give greater weight to patients' wishes in a more formal sense than we have before. Those who have strong feelings about how they want themselves or their loved ones to be treated should expect those feelings to be considered.
"Our guidance aims to ensure that all doctors are aware of the ethical and legal principles that should underpin practice in end-of-life care and to let patients know what they can expect from their doctor.
"While the end-of-life consultation touches on many emotionally difficult subjects, this is not a debate about assisted suicide. Our guidance to doctors on this matter will always remain within the law."
The guidance is the first issued by the GMC to cover cardiopulmonary resuscitation (CPR), clinically assisted nutrition and hydration, such as tube feeding, and how to deal with end-of-life care for infants and children. It also gives advice on how and when doctors should raise the issue of organ donation.
The Association of Anaesthetists of Great Britain and Ireland will also issue guidelines to its members this month regarding the degree of life support patients receive during surgery.
Les Gemmell, a consultant anaesthetist and chairman of the anaesthetists' guideline working party, said the guidelines advise anaesthetists on how to handle cases where patients with "do not resuscitate" orders are due to have pain-relieving operations, such as to remove a bowel obstruction.
The guidelines set out three options patients can choose. The first will be to retain their "do not resuscitate order"; the second will involve modifying the order so the patient can, for example, be given drugs that counteract the effects of the anaesthesia; the third will be to completely remove the order.
Gemmell said: "An anaesthetic can slow the heart rate and we can give patients drugs to counteract that, which could be regarded as resuscitation.
"The success rate for resuscitation from anaesthesia is 92% but if the patient is on the ward it's below 15%, so the patient needs to know the facts."
The association will also run a podcast explaining the guidelines on its website.
Dr Vivienne Nathanson, head of science and ethics at the British Medical Association, said: "This type of advice provides a good steer for doctors on how to approach the difficult area of end-of-life care.
"It is essential that doctors and patients talk together about the best way forward in these circumstances.
"We believe that doctors already follow this advice, but additional clarification is always welcome."
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