End of life care and DNAR

Rachel Podolak, Head of Welsh Affairs

Who we are and what we do Our role is to protect,

promote and maintain the

health and safety of the

public.

• We maintain the register of doctors and set the standard for entry to the register

• We set and promote the principles and values of good medical practice from medical school to retirement.

• We take action to protect patients.

MMaanncchheesstteerr

.

Hitting the headlines

End of life care - key principles

The presumption in favour of prolonging life -

not an absolute obligation

Life-prolonging treatment can be withdrawn or

not started – if refused; or if it is not of overall

benefit to a patient who lacks capacity to

decide

Plan ahead as much as possible with the

patient, healthcare team, carers and other

services

Provide appropriate palliative care e.g. pain

relief

Respect patients’ views and wishes. Treat

patients and their carers with sensitivity,

dignity, and fairness

Issues covered in the guidance

Equalities and human rights 7-13 Advance care planning (incl. palliative care) 50-

62

Advance requests for/refusals of treatment 63-74

Clinically assisted (artificial) nutrition and hydration (C/ANH) 112-127

Cardiopulmonary resuscitation (CPR) 128-146

Advance requests

Advance requests for treatment:

Not legally binding – evidence of a patient’s wishes

Will carry weight in future decisions about the balance of

benefits, burdens and risks of treatment.

If the benefits, burdens & risks of a treatment are finely

balanced; the patient’s previous request to have it will

usually be the deciding factor.

Advance refusals

Advance refusals of treatment:

Must be ‘valid and applicable’ to be legally

binding

If not – then treat as evidence of a patient’s

wishes

Do Not Attempt CPR decisions

The decision making principles that apply

to other treatments also apply to CPR when

doctors are deciding if it should be

attempted at a future date. We ask doctors

to be clear about:

when to talk about a DNACPR order with

patients and/or their family and carers

what to explain – public myths; patients’

fears

whether they are ‘consulting’ or

‘informing’

the different roles of the doctor/team,

patient and family, in making the

decision

Decision making

And finally….

Questions you may wish to consider:

Was it good clinical practice (up to date, evidence based)?

Were GMC decision-making principles applied?

Were the issues considered carefully; and was advice sought?

Did the Dr make a ‘reasonable’ decision in the circumstances?