Editorials

GMC guidance on end of life care

BMJ 2010; 340 doi: http://dx.doi.org/10.1136/bmj.c3231 (Published 22 June 2010) Cite this as: BMJ 2010;340:c3231
  1. Dominic Bell, consultant in intensive care/anaesthesia
  1. 1General Infirmary at Leeds, Leeds LS1 3EX
  1. dominic.bell{at}leedsth.nhs.uk

    Important changes for clinicians take effect on 1 July

    The recently published guidance from the General Medical Council (GMC) on end of life care comes into force on 1 July 2010 and commands the attention of all doctors in the United Kingdom by emphasising that failure to comply will place registration at risk.1

    Change became essential following the Mental Capacity Act 2005 and after reviews reported how patients with terminal illness are denied informed choice regarding the remainder of their life and the manner in which they die.2 Doctors have been seeking advice from the GMC on these difficulties and should reasonably expect the regulatory body to provide unequivocal guidance on optimal care and how professional censure can be avoided. This last aspect became particularly important after legal challenge to the previous guidelines, in which it was held that medical opinion would not determine a patient’s best interests.3

    The GMC’s standards and ethics reference group responded by initiating a review in 2007 under an outside chair, with a consultation involving all potential interest groups, and validated by independent audit.

    The key conceptual changes to clinical practice are that death should become an explicit discussion point when patients are likely to die within 12 months, and that medical paternalism on the subject, however benignly intended, must be replaced by patient choice (box). Doctors will be expected to document that …

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