Making challenging ethical decisions

IN the ongoing COVID-19 pandemic, clinicians may be called upon to make difficult ethical decisions, such as which patient gets the last ventilator.

MDDUS understands that doctors are concerned about the potential GMC, or even criminal, ramifications of withholding or withdrawing treatment from patients based on availability of resources. We are here to support our members through this challenging time and wish to reassure clinicians that you are not alone if faced with such a situation.

MDDUS liaises regularly with the GMC and other relevant bodies, and we will continue to do so as the current situation evolves to ensure guidance is as clear and applicable as possible.

Doctors must ensure that they act in accordance with the law. No one should feel pressure to make a difficult decision in isolation; you should involve your colleagues in challenging decisions or contact MDDUS for advice.

MDDUS advises that doctors involve their NHS employer’s legal team early when they have concerns about making a particular decision to withdraw or withhold life-sustaining treatment from a patient. In situations, such as considering reallocating life-saving treatment from one patient to another due to limitations on resources, the employer’s legal advisers should be informed without delay to ensure access to relevant emergency court/judicial involvement.

A doctor should be assisted by their employer and their legal representatives when making such critical decisions. Should you be unsure how to contact your employer’s legal advisers in an emergency, speak to the clinical lead or on-call manager. MDDUS members can also access expert advice and support via our telephone advisory service.

The GMC’s Treatment and care towards the end of life provides guidance to doctors caring for patients approaching the end of life, including those patients with life-threatening acute conditions caused by sudden catastrophic events. The GMC reminds doctors that they must continue to make the care of patients their first concern. The guidance highlights that doctors should not make decisions about withholding or withdrawing care solely based on resource constraints.

However, GMC guidance in relation to COVID-19 recognises that doctors may be asked to make urgent and clinically complex decisions, and that their practice may change at this unprecedented time. Nevertheless, doctors must ensure decisions are individualised to that patient and take account of all relevant factors, such as clinical appropriateness and the patient’s wishes. Doctors must be able to explain and justify any decisions they make or action they take.

Again, MDDUS members can contact us for advice and support.