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Hot topic: End of life care

Prof-Peter-RubinProfessor Sir Peter Rubin, chair of the GMC, looks at end of life care

Talking to someone about their end of life care is never easy. Proper palliative care and considered communication are vital if a patient is to have the “good death” that we would wish for ourselves.

However, our reluctance as a society to talk about death means that too few patients get the opportunity to experience this. As doctors, though, we must work in partnership with patients, and those close to them, to provide the best possible care. This is why the GMC has published clear, concise guidance to help doctors navigate the complex decisions and ethical dilemmas that can arise when patients are approaching the end of life.

Doctors must take the lead on this. We need to create opportunities for patients to talk about their death, where they want to die, and any other wishes or concerns they may have. We need to explain what options are available to them, and what each may mean in terms of burden, benefit and risk. We also need to allow for their plans to alter as their condition progresses.

And this partnership goes beyond patients. We need to communicate with all those involved in treatment and care, and assume responsibility if and when patients move between their own home, care home, hospital and hospice. Crucially, we need to acknowledge the roles and responsibilities of those close to patients. This is particularly true when capacity is impaired: we must ensure they are given the time and information they need to reach consensus. The GMC’s guidance offers clear decisionmaking models to assist on this, as well as further case studies.

I don’t underestimate the difficulties that can and do arise. End of life care is one of the most challenging areas of practice. But, since Dame Cicely Saunders founded the hospice movement, the UK has, albeit quietly, led the world in this area. Every day doctors are having hard conversations with patients and their families and helping them make incredibly difficult decisions. This guidance, with its emphasis on partnership, on conversation, is there to support us as we do that, and ensure more patients experience a “good death”.

Useful links

  • GMC, Consent: Patients and Doctors Making Decisions Together
  • GMC, Treatment and Care Towards the End of Life: Good Practice in Decision Making