confidentiality, but must consider whether the patient would regard such a discussion as a breach of trust (especially if they have asked the doctor not to involve certain people). In the absence of an advance decision or legal authority, any decision


made for a patient who lacks capacity must be made in the patient’s best interests, taking into account their past and present wishes and feelings, beliefs and values. The patient’s preferences may be highlighted by those close to the patient as well as the healthcare team.


Addressing concerns, making decisions Doctors should proactively seek the preferred medical management of a patient nearing the end of their life, if they have not otherwise objected. Furthermore, doctors have a legal and professional obligation to involve patients and those close to them in “do not attempt cardiopulmonary resuscitation” (DNACPR) decisions (unless this would cause significant harm). In their guidance Treatment and care towards the end of life, the GMC encourages doctors to make sound clinical judgement, explain the clinical issues and support patients and their loved ones during emotional and uncertain times. Doctors are reminded to share information about advance care plans, advance decisions and lasting power of attorney (England and Wales)/welfare attorney (Scotland). Caring for older patients is a privilege and an important


responsibility. The GMC provides a useful summary when considering the care of older patients generally when it states: “You must give [these] patients… the same quality of care as all other


patients. You must treat patients and those close to them with dignity, respect and compassion, especially when they are facing difficult situations and decisions about care. You must respect their privacy and right to confidentiality”.


Dr Greg Dollman is a medical adviser at MDDUS


Link: • GMC – Better care for older people: tinyurl.com/qhfpvc3


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