The General Medical Council, the profession's regulator, says early discussions can help avoid misunderstandings and conflict.

In new guidelines, the GMC says doctors should start from the assumption that life should be prolonged, although not at any cost.

Opportunities should also be sought to discuss organ donation.

It has long been the case that patients have a legal right to refuse treatment, but in recent years there has been controversy about the right of patients to be tube fed or hydrated right up until the point of death if doctors do not feel it is beneficial.

The GMC guidance states that in some cases providing nutrition or hydration at the end of life may cause unnecessary suffering.

It also notes there are times when attempts at resuscitation with CPR may not be in a patient's best interests, as an inevitable death can be transformed into a traumatic experience.

A discussion about the benefits, burdens and risks should be had with the patient and those close to them.

In some cases it may be appropriate for the doctor to decide not to offer such treatment, but for the most part it will be the patient's request which is the "deciding factor", the new guidelines state.

The regulators do not address the issue of assisted suicide, which is illegal in the UK.

No preconceptions

It is hoped having the opportunity to discuss a care plan in advance should allay patients' concerns that they may be under- or over-treated in their final days and hours, and that all decisions will be directed by their doctor.

It will also allow patients to think about where they would like to die.

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