End of life dilemma

The scene

An elderly patient who suffered from a progressive degenerative disease informed his GP that his illness was affecting his quality of life to the extent that he intended to commit suicide. The patient explained that his son was going away for a few days, and while he was away, the patient intended to end his own life. He expressly forbade the GP to inform his son of his intentions.

The patient agreed to being referred to a psychiatrist, who concurred with the GP's opinion that the patient was not depressed, and had the capacity to make a decision to end his life.

The member rang the MDU advisory helpline to ask whether he could justify breaching this patient's confidentiality in the circumstances.

MDU advice

The MDU adviser discussed the situation with the GP member, reminding him that the GMC makes it clear that patients have a right to expect information about them to be held in confidence by their doctors. The GMC advises that express consent should be sought from patients for disclosures of personal information, save in exceptional circumstances.

Paragraph 51 of the GMC's guidance Confidentiality (2009) states that although it may be appropriate to encourage patients to consent to disclosures necessary for their own protection, a doctor should usually abide by a competent adult patient's refusal to consent to disclosure, even if their decision leaves them, but nobody else, at risk of serious harm.

In this case, the GP faced an unusual dilemma in that either decision – to breach or to respect the patient's confidentiality – could have serious consequences. The GP reported that he judged the patient to have capacity to make the decision to end his life.

If he respected the patient's confidentiality, the MDU advised that the GP might face a complaint from the patient's family that he did not inform them. Conversely, a decision to breach his patient's confidentiality may lead to a breakdown in trust between doctor and patient, and a complaint from the patient and the doctor might be called upon by the GMC to justify such a decision.

He was advised to document carefully all the steps he took to reach his decision.

The MDU adviser also discussed with the GP the reasons why the patient might want to take his own life. In circumstances such as these, where a carer may be leaving the patient alone for a while, fear of coping may trigger thoughts of suicide. The GP, and other healthcare professionals involved in the patient's treatment, had already determined that the patient had other reasons for contemplating suicide, principal amongst these a desire not to be a burden on others.

As a result of the medico-legal advice, the GP concluded that it was not necessary to breach the patient's confidence and persuaded him to allow referral to his neurologist to optimise symptom control, as well as arranging for carers and the community psychiatric nursing team to provide the patient with additional support during his son's holiday. The patient did not carry out his threat to end his life.

This page was correct at publication on 17/12/2010. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.