'Listen to patients' advice on way

The General Medical Council, which has drawn up the guidelines, said patients must be given the opportunity in advance to discuss what treatment and care they want towards the end of life.

It emphasises to doctors the importance of listening to patients and recording an advance care plan to help ensure that everyone involved follows a patient's wishes.

But the guidance still enables doctors to exercise their own judgment in deciding whether or not to discuss making Do Not Resuscitate (DNR) orders with patients and their families.

It says doctors are not obliged to carry out cardiopulmonary resuscitation (CPR), even if patients want it, if they believe it would not be clinically appropriate.

CPR attempts to restart a patient's heart or breathing and restore their circulation. Evidence suggests that generally the procedure has a very low success rate and carries significant risks for patients even if it does work.

The guidance says doctors must start from a presumption in favour of prolonging life and must not be motivated by a desire to bring about the patient's death.

However there is no absolute obligation to prolong life irrespective of the consequences for the patient and irrespective of the patient's views.

It continues: "If a patient is at foreseeable risk of cardiac or respiratory arrest and you judge that CPR should not be attempted, because it will not be successful in restarting the patient's heart and breathing and restoring circulation, you must carefully consider whether it is necessary or appropriate to tell the patient that a DNA CPR decision has been made.

"While some patients may want to be told, others may find discussion about interventions that would not be clinically appropriate burdensome and of little or no value.

"If you conclude that the patient does not wish to know about or discuss a DNA CPR decision, you should seek their agreement to share with those close to them, with carers and others, the information they may need to know in order to support the patient's treatment and care."