25.3 Decisions to withdraw or withhold life-prolonging treatment should be subject to review and audit. Treatment providers and health care facilities have an ethical obligation to audit regularly their own patterns of decision making and compare them with wider trends. Health Authorities should be encouraged to provide local guidelines addressing the decision-making process with a system of audit to ensure that the guidelines are being followed. Doctors must be able to demonstrate that their treatment recommendations comply with a responsible body of medical opinion. Advice must be sought from professional bodies and the General Medical Council if anomalous patterns of decision making are identified in comparison with those of other clinicians or other similar facilities.
Managers have an obligation to investigate promptly such trends in their facilities.
Those treating patients who lack the capacity to make or communicate decisions need to be aware of the dangers of decisions to withhold or withdraw treatment becoming routinised. A constant awareness is needed that each individual decision must be carefully considered in order to ascertain whether the treatment would provide a net benefit to the particular patient and the doctor must be willing to justify the decision if called upon to do so. Last modified 17th October 2000.