Doctors who act contrary to the wishes of dying or comatose patients could be judged to be causing harm and struck off under new rules from the medical regulator.

The General Medical Council (GMC) will publish draft guidance this month advising doctors how they should approach decisions surrounding the “end of life”, including whether to withhold treatment from terminally ill patients, turn off life support or attempt resuscitation.

The advice for all 150,000 practising doctors in Britain covers all life-threatening conditions or permanent disabilities, including heart failure, brain damage and cancer.

But it avoids mention of assisted suicide, or actively helping a patient to die, which remains illegal, despite calls for a change in the law.

In a further sign of the medical profession’s desire to increase patient choice in end-of-life care, the Association of Anaesthetists of Great Britain and Ireland will also issue guidelines this month. The recommendations will focus on providing enough information for patients to make an informed choice on the degree of life support they receive during surgery.

Both sets of guidelines underline a shift in the debate in how critically ill patients are treated. They are designed to clarify the ethical issues for doctors in the light of recent cases that have contested decisions about providing or withholding treatment.

Legal precedents suggest that doctors, not patients, have the final say over whether to provide life-extending treatment or nutrition. At present they can refuse to do so if they judge it to be futile or not in the “best interests” of the patient, because of possible pain or suffering.

But the guidance from the GMC formally advises doctors for the first time that patients’ wishes – or those of their loved ones – should be given much greater weight in situations where there is a chance to prolong or save life, even for a short time.

The guidance suggests all options should be discussed with a patient, even those not available on the NHS.

Where a patient’s wishes are explicit or interpreted by close family or their legal representatives, “acting against the patient’s wishes should be deemed to be causing harm”, it adds.

“Serious or persistent failure to follow this guidance will put your registration at risk,” the guidance states. “You must, therefore, be prepared to explain and justify your actions.”

Jane O’Brien, assistant director of standards and ethics at the GMC, said that it expected doctors to take “all reasonable steps” to consider a patient’s wishes in delicate cases such as the withdrawal of life support for patients unlikely to recover. “Clinicians still have the final say on ‘best interests’, but we are asking them to give greater weight to patients’ wishes in a more formal sense than we have before,” she said. “Those who have strong feelings about how they want themselves or their loved ones to be treated should expect those feelings to be considered.”

Doctors should consult the family or a patient’s legal representatives if they do not have the capacity to speak for themselves, she added. Patients also have the right to refuse treatment “and a valid advance refusal must be respected, even if it will result in their death”, Ms O’Brien added.

Roughly 60 per cent of all deaths in Britain occur in hospital. The latest advice updates Withholding or Withdrawing Life-Prolonging Treatment, guidance for doctors published by the GMC in 2002, and since subject to legal scrutiny.

Cases include that of Charlotte Wyatt, the severely disabled baby, whose parents won a legal battle in 2005 to ensure that she would be resuscitated if she fell ill. Doctors had given Charlotte only a 5 per cent chance of survival after she was born three months prematurely, but she is now 5.

Four years ago the GMC decided to strike off Michael Irwin, a GP, after he tried to help a terminally ill friend to die. The 77-year-old, who received a police caution, was found guilty of serious professional misconduct. He now advises patients on visiting Dignitas, the Swiss euthanasia clinic. Welcoming the new guidance, he said: “There is sometimes too much emphasis on trying to keep people alive at all costs when, with a bit more experience, you could make their final days more comfortable in line with their wishes.”

The National Council for Palliative Care said guidance was also required in the light of the Mental Capacity Act 2005, which lets people express preferences about treatment should they lose the capacity to decide.

Vivienne Nathanson, the head of science and ethics at the British Medical Association, said that the GMC’s advice would provide “a good steer for doctors on how to approach the difficult area of end-of-life care”.

Les Gemmell, a consultant anaesthetist and chairman of the anaesthetists’ guideline working party, said it was vital that patients, such as cancer sufferers requiring further pain relief operations, had the time to consider their situation and retain a control over their care. “People are now much more willing to talk about end-of-life decisions and it is important to be absolutely clear with patients as to the possible outcomes,” he said.

Mark Platt, director of policy for National Voices, the association of charities and patients’ groups, welcomed the GMC’s consultation.

Reaching a final decision

- The draft guidance for doctors covers clinical decision-making in serious and life-threatening conditions and disabilities including heart failure, brain damage and cancer. It also applies to permanent vegetative states or “an irrevocable loss of awareness”

- Doctors are advised to consult colleagues and not take decisions independently when considering a “life-limiting” condition, shifting from trying to cure a patient to easing their pain

- Further decisions include whether or not to withhold treatment from the terminally ill, to turn off life-support machines, withdraw feeding or hydration tubes or attempt resuscitation

- All “reasonable steps” should be taken to consider a patient’s wishes and discussions should start before they lose capacity or consciousness

- Where patients are not capable of making decisions, family or legal representatives should be asked what they would have wanted. “Acting against the patient’s wishes should be deemed to be causing harm,” the guidance adds

- Actively helping someone to kill themselves is a crime under the 1961 Suicide Act, and is not addressed by the guidance

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