Guidelines for UK doctors about taking decisions on withholding or withdrawing treatment from patients are expected to be approved by the General Medical Council this month and issued to every doctor on the register.
News of the impending guidance emerged this week as the Department of Health announced the death of the quadriplegic woman known only as Ms B, who won a court ruling in March allowing the ventilator keeping her alive to be switched off.
The guidelines were prompted by concerns aired in the press about the withdrawal of treatment from elderly patients and by a number of cases in which patients or their relatives were distressed to discover that “do not attempt resuscitation” orders had been made without their knowledge.
A GMC spokesman said that the guidance, drawn up by a working group of the standards committee led by Professor David Hatch, “sets out the legal and ethical framework for taking decisions and will go to the council in May for final approval.”
The guidelines remind doctors that patients who are mentally competent have a legal right to refuse treatment even if the outcome is certain death.
Patients must not be assumed to lack mental capacity just because their decision might seem irrational or seems to doctors not to be in their best interests. Advance refusals of treatment by a patient who later loses capacity are also legally binding, where they are applicable to the patient's current circumstances and there is no reason to believe the patient later changed his or her mind.
Doctors with a conscientious objection to a decision not to start or go on with life prolonging treatment may withdraw from the patient's care, but must hand the care over without delay to another suitably qualified colleague so that patient care does not suffer.
The guidance takes account of differences among the United Kingdom's three legal jurisdictions—England and Wales, Scotland, and Northern Ireland. In Scotland, proxy decision makers may be appointed for patients without the capacity to decide for themselves.
In England and Wales, doctors must take decisions for patients who are mentally incompetent, acting in the patient's best interests and weighing up the benefits and burdens of the proposed treatment.
Doctors are reminded that they must not allow factors such as the patient's age, disability, or lifestyle to prejudice the choice of treatment.