Tens of thousands of patients are having do not resuscitate orders imposed without their families' consent, an audit has found.
Hospitals are failing to tell relations that they do not intend to attempt potentially lifesaving techniques to save their loved ones, according to the Royal College of Physicians.
Its audit of 9,000 dying patients found that one in five families were not informed of the plans - equivalent to 40,000 patients a year, the Daily Telegraph reported.
The college estimated that 200,000 patients each year are issued with the order for health workers not to attempt cardiopulmonary resuscitation (CPR).
In 16% of cases the study found there was no record of a conversation with the patient about the order.
The audit's chairman Professor Sam Ahmedzai told the Telegraph: "When a decision has been taken, it is unforgivable not to have a conversation with the patient - if they are conscious and able - or with the family."
He also said doctors needed to be more open with dying patients, as half of patients identified as likely to be dying were dead within a day.
"This is being done very late in the day - as doctors we just don't like to face up to it," Prof Ahmedzai added.
An NHS England spokeswoman said: "We welcome the results of this audit, which we commissioned, and which shows there has been some improvement in the care provided.
"But there is clearly more that can be done.
"Although this audit presents a snapshot of end-of-life care within NHS hospitals, there are clear variations in the support and services received across hospitals and areas where improvements must continue to be made."