Policies and Guidelines
End of life issues
We list here some useful resources to consider when reflecting on ethical issues that can arise in treating and caring for people at the end of life.
General Medical Council
This is the GMC’s over-arching guidance on decisions about treatment and care for people (neonates to adults) approaching the end of life. In this guidance, people are regarded as ‘approaching the end of life’ when they are likely to die within the next twelve months. It takes account of relevant statutory and common law but is expressly not a substitute for legal advice. The GMC intends this guidance to be read as an expansion on its ‘Good Medical Practice’ and ‘Consent: patients and doctors making decisions together’.
Against a background discussion of underlying principles and decision-making models, the guidance addresses several considerations arising from treatment and care towards the end of life. These include: advance care planning; advance requests and refusals; nutrition, hydration and clinically assisted nutrition and hydration; and cardiopulmonary resuscitation.
British Medical Association (BMA)
This BMA report summarises the contents of other BMA publications concerning end-of-life decisions, including Withdrawing and withholding life-prolonging medical treatment (3rd edition 2007) and Advance decisions and proxy decision-making in medical treatment and research (2007).
The three main issues dealt with in this document are:
- contemporaneous and advance refusal of treatment
- withholding and withdrawing life-prolonging medical treatment
- assisted dying: euthanasia and assisted suicide
In addition, there are BMA publications and policy documents relating to several other issues concerning the end of life. These include:
- Assisted dying: BMA policy
- Assisted suicide: responding to patient requests – guidance for doctors in England Wales and Northern Ireland
- Cardiopulmonary resuscitation: helping you make decisions
- This is jointly published guidance from the BMA, the Resuscitation Council (UK) and the Royal College of Nursing
- Decision-making: withdrawing or withholding artificial nutrition and hydration (ANH) in relation to patients in a minimally conscious state
- The impact of the Human Rights Act 1998 on medical decision-making (2007)
- This document provides useful contextual information when considering end-of-life issues. It discusses, for example, the relevance of Article 2 (right to life) to withdrawing and withholding treatment, and the relevance of Article 3 (prohibition of torture) to ‘dignity in death’.
Of the many statutory and common law requirements relevant to end-of-life issues, the Codes of Practice of the Human Tissue Act 2004 and the Mental Capacity Act 2005 are particularly useful resources.
Human Tissue Act 2004
The Human Tissue Authority provides nine codes of practice , updated in 2014 to reflect recent policy decisions and legal advice, intended to give professionals practical guidance on interpretation and application of human tissue legislation
Mental Capacity Act 2005
The Mental Capacity Act 2005 Code of Practice (2007) provides practical guidance in support of the Act. In addition to setting out the five statutory principles behind the Act and explaining its application, provisions of particular relevance to the end of life include those on: assessing and making decisions in the best interests of someone lacking capacity (Ch 5); Lasting Powers of Attorney (Ch7); the role of the Court of Protection (Ch 8); advance decisions to refuse medical treatment (Ch 9); the role of Independent Mental Capacity Advocates (Ch 10).
NHS Scotland DNACPR Policy Document