GMC: Treatment and Care Towards the End of Life: Summary

SJT Textbook: Treatment and Care Towards the End of Life

GMC End of Life Care

This GMC end of life care guidance explains how doctors must lawfully balance patient wishes, capacity, best interests, DNACPR decisions, and advance care planning when a patient is approaching death.

🎥 Video Lesson (YouTube)

🎧 Podcast Lesson (Spotify / Apple / Amazon)

🎯 THE CORE PRINCIPLE

Treatment and care towards the end of life is about balancing compassion, patient autonomy, clinical judgement, and legal duties when a patient is approaching death. It covers decisions about life-prolonging treatment, advance care planning, CPR, clinically assisted nutrition and hydration, and the role of relatives and the multidisciplinary team.

For patients with capacity, shared decision making is essential, and their choice to accept or refuse treatment must be respected. For patients without capacity, all decisions must be made in their best interests, using the least restrictive option and involving those close to the patient and any legal proxy.

In the MSRA SJT, high-scoring answers demonstrate early planning, honest communication, lawful capacity assessment, proper involvement of relatives, proportional treatment, and meticulous documentation.

GMC end of life care requires lawful capacity assessment for every major decision.

⚡ HIGH-YIELD ACTIONS (What Scores Points)

1. Assess and document the patient’s capacity for each major decision.
2. Explore and respect the patient’s wishes, values, and advance decisions.
3. Use shared decision making for patients with capacity.
4. Apply the best interests framework for patients without capacity.
5. Involve relatives, partners, and legal proxies appropriately.
6. Hold early advance care planning discussions.
7. Make DNACPR decisions based on clinical appropriateness and patient wishes.
8. Review the appropriateness of clinically assisted nutrition and hydration.
9. Seek senior and MDT input for complex decisions.
10. Document clearly all discussions, decisions, and rationales.

MSRA SJT frequently tests breaches of GMC end of life care guidance.

These traps over-prioritise family wishes, avoid lawful capacity assessment, or default to non-beneficial treatment.

💬 MODEL PHRASES (Use These in SJT Logic)

* “I will explore the patient’s wishes and any advance care plan.”
* “This decision must be in the patient’s best interests.”
* “I will involve the MDT and those close to the patient.”
* “I will explain DNACPR sensitively and clearly.”
* “I will document the discussion and outcome carefully.”

DNACPR decisions sit at the centre of GMC end of life care law.

B – Best interests,
E – Explore wishes
S – Senior and MDT input
T – Talk early
C – Capacity assessment
A – Advance care planning
R – Relatives involved appropriately
E – Everything documented

Advance care planning is a core part of GMC end of life care.

📋 QUICK FAQ

Can a patient with capacity refuse life-prolonging treatment?
Yes. A capacitous patient has the right to refuse any treatment, even if it may result in death. Who decides for a patient without capacity?
The decision is made by the treating team in the patient’s best interests, informed by relatives and any legal proxy. Does a DNACPR mean no treatment?
No. It applies only to CPR and does not limit other active or palliative treatments. Must relatives agree with end-of-life decisions?
Relatives should be consulted, but they do not legally decide unless appointed as a proxy. Is clinically assisted nutrition and hydration always required?
No. It should only be provided if clinically appropriate and in line with the patient’s wishes or best interests.

Best-interests decisions underpin GMC end of life care for patients lacking capacity.

📚 GMC ANCHOR POINTS

• Shared decision making – Treatment and Care Towards the End of Life
• Capacity and best interests – Mental Capacity Act 2005
• Advance care planning – End of Life Guidance
• DNACPR decisions – End of Life and CPR Guidance
• Role of relatives – Confidentiality and End of Life Guidance

💡 MINI PRACTICE SCENARIO

An elderly patient with advanced cancer refuses further chemotherapy and requests comfort care only. Best action: Respect the patient’s capacitous refusal and initiate a palliative care approach. Why: A patient with capacity has the right to refuse treatment, even if refusal may shorten life.

🎯 KEY TAKEAWAYS

✓ Capacity must be assessed for each decision
✓ Advance wishes guide care
✓ Best interests apply when capacity is lacking
✓ Relatives inform but usually do not decide
✓ DNACPR is about CPR only
✓ Documentation is essential
✓ Compassionate communication is mandatory

🔗 RELATED TOPICS

* → Decision Making and Consent
* → Mental Capacity
* → Duty of Candour
* → Confidentiality
* → Raising Concerns About Patient Safety

📖 FULL PRACTICE QUESTIONS

Example SJT — Best of 3 (8 options; choose three)

A patient with terminal illness has lost capacity and has no advance decision. The family request full escalation despite medical consensus that it is futile.

Options:
A. Follow the family’s wishes immediately
B. Apply a best interests decision
C. Seek MDT and senior input
D. Provide all possible treatment regardless
E. Explain the situation sensitively to the family
F. Document the decision-making process
G. Avoid discussion to prevent distress
H. Transfer responsibility to another team

Example SJT — Rank 5 (best → worst)

A patient with capacity refuses CPR but the family strongly disagree.

Options:
A. Respect the patient’s decision and document
B. Re-check capacity and confirm understanding
C. Explain the decision to the family sensitively
D. Delay until agreement is reached
E. Perform CPR to avoid conflict