1. The medical patient / carer contact: we can do better 15 th December 2014 Victoria Carson Achyut Valluri Head of Scottish Affairs Clinical Fellow

3. Issues being raised to us by doctors in the UK

4. End of life care: How confident are doctors? Doctors rated their confidence in delivering end of life care on average 6.8 out of 10. Source: National Audit Office: http://www.nao.org.uk/wp- content/uploads/2008/11/07081043_Doctorssurvey.pdfhttp://www.nao.org.uk/wp- content/uploads/2008/11/07081043_Doctorssurvey.pdf

5. End of life care guidance

6. Issues covered in the guidance  Equalities and human rights 7-13  Presumption in favour of prolonging life 7-13  Two decision-making ‘models’ 14 and 16  Advance care planning (incl. palliative care) 50-62  Advance requests for/refusals of treatment 63-74  Organ donation 81-82  Care of neonates, children and young people 90-108  Clinically assisted nutrition and hydration (C/ANH) 112-127  Cardiopulmonary resuscitation (CPR) 128-146  Care after death 83-87

7. Key principles  Act within the law  Presumption in favour of prolonging life– not an absolute obligation  Life-prolonging treatment can be withdrawn or not started – if refused – if it is not of overall benefit to a patient who lacks capacity to decide  Plan ahead as much as possible with the patient,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, when needed  Respect patients’ views and wishes. Treat patients and their carers with sensitivity, dignity, and fairness

8. When patients lack capacity

9. Online resources http:// www.gmc-uk.org/guidance/ethical_guidance/end_of_life_care.asp

11. Overall benefit The decisions you or others make on the patient’s behalf must be based on whether treatment would be of overall benefit to the patient, and which option (including the option not to treat) would be least restrictive of the patient’s future choices GMC End of life care guidance paragraph 13

12. The medical patient / carer contact: we can do better In addition to up to date, evidence-based practice  Apply decision-making frameworks  Communication / Partnership with patients / carers

13. The GMC in Scotland 5 th Floor, The Tun 4 Jackson’s Entry Edinburgh EH8 8PJ 0131 525 8700 GMCScotland@gmc-uk.org @gmcuk