The Scottish Academy of Medical Royal Colleges (the ‘Scottish Academy’), the Royal College of Physicians of Edinburgh (the ‘College’), Marie Curie and Scottish Care have co-produced new guiding principles, designed to ensure that dying patients in Scotland are treated humanely, compassionately and with dignity during the COVID-19 pandemic. They want the Scottish Government to adopt the guidelines as a matter of urgency.

The principles say that all patients in Scotland who are judged to be dying from COVID-19 or other terminal conditions - within hours or days - must receive equal access to visits from family or friends.

Deaths from COVID-19 and other diseases and illness occur across the entire range of care facilities in Scotland. Patients die at home, in nursing and residential homes, in hospices, community hospitals, general wards of acute hospitals, emergency departments, and high dependency and intensive care units.

Although a national approach to end of life visiting is essential, current UK Government guidance on travel from home during COVID-19 does not explicitly specify that visits to a dying family member is allowed.

As a consequence, inconsistent interpretations of this guidance mean that variable policies are in place. Some are more stringent, and limit or may entirely exclude access of family to a patient dying of COVID-19. Other approaches are more lenient and permit exceptions sometimes without explicit consideration of the wider implications of population harm or PPE limitations.

The new principles therefore set out a path to allowing family or friends to safely visit dying patients using the correct personal protective equipment, treating all dying patients equally with dignity and compassion, while protecting other patients, visitors and healthcare workers.

Commenting, Professor Andrew Elder, president of the Royal College of Physicians of Edinburgh and Geriatrician said:

Decisions regarding the presence of family at the bedside of their dying relative are not simply matters of infection control. And we should not permit them to be such. They are matters of our humanity; matters that define who we are, our understanding of what life is, and how our lives must end. We know how we will make people feel if we unnecessarily prevent them from being with a loved one at the time of their death. We do not need to make them feel that way; we can find ways to allow families to be together at this time. With personal protective equipment, social distancing, and isolation, family members can balance risk to themselves and others just as the caring professions do. We are calling on the Scottish Government to adopt our principles to support families to visit their loved ones at this sombre and difficult time.

Chair of the Scottish Academy and GP, Dr Miles Mack said:

It is absolutely essential that family and friends understand the access they should expect when they visit a dying patient to whom they are close, across all care settings including nursing and residential homes, hospices, and hospitals. That should remain the case during the COVID-19 pandemic and we should redouble our efforts to ensure that families and patients have equal access to visits. But this must also be done in a way which protects healthcare staff, other patients, and visitors. That is why we have published these new guiding principles, which we hope will be adopted by all primary, secondary and community care settings in Scotland at the direction of the Scottish Government.

Julie Pearce Chief Nurse, Executive Director of Quality & Caring Services, Marie Curie said:

Marie Curie cares for people coming to the end of their lives every day and we know just how important that moment of good bye is between the person and their family and friends. Even during this pandemic, wherever possible, we should try to make this happen in person. The chance to say goodbye is so important and if missed can have a huge impact on the person’s last moments and their family and friend’s grief and bereavement. We can work with staff and families to ensure that PPE is in place to keep people as safe as possible. Where visiting in person is impossible then we know that staff are committed to facilitating virtual visits and making the connections with families in the best way they can, in a kind, compassionate and personal way. We fully endorse these guidelines published today, and hope that they are adopted by the Scottish Government and considered right across the UK.