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GMC guidance
  1. Anne Thomson, Specialist Nurse
  1. Anne Thomson is Multiple Sclerosis Specialist Nurse, NHS Ayrshire & Arran. Email:

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In Tolstoy’s (1960) The Death of Ivan Ilyich, Ivan feels ‘tormented by lies’. When Ivan seeks the advice of a doctor, he is suffering. He is experiencing extreme pain. His consultation with the doctor, however, is wholly unsatisfactory. Following questioning and examination Ivan asks whether his case is serious. The doctor ignores the inquiry. Ivan asks again, saying, ‘we sick people, no doubt, ask inappropriate questions, but tell me, is this complaint dangerous…?’ Ivan is admonished by a harsh look and is reminded that the doctor had already told him what was necessary.

Historically, doctors have tended to be highly paternalistic towards the people in their care. Although over time doctors have become therapeutically more potent, and now place greater emphasis on good communication, they often fail to give patients what they want, particularly towards the end of life (Ajaj et al, 2001; Wilson, 2008). This is recognised in both The Scottish Government’s (2008) Living and Dying Well framework and the Department of Health’s (2008) End of Life Care Strategy: Promoting High Quality Care for all Adults at the End of Life. The process of end-of-life care decision-making should be a key part of patient care. Patients should no longer feel their questions are being ignored or their enquiries about their condition are unacceptable. Therefore, the General Medical Council (GMC) has produced guidelines for doctors relating to best management at the end of life — Treatment and Care Towards the End of Life: Good Practice in Decision Making (GMC, 2010). Although these are aimed primarily at doctors, they will also be of help and interest to nurses and guide them in conversations with patients, at what is a stressful time. Samanta and Samanta (2010) believe that nurses play a central role in end-of-life care and can, through …

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