The advance care planning process

Definition of Advance Care Planning

Patients can make decisions about the care they want to receive with the support of The advance care planning process. The situation may arise at a time in the future when they cannot tell people what they want. A person’s health and independence will be maximized as they move toward the end of their lives through Advance Care Planning. Health care professionals, the individual in question, as well as any loved ones they would like to be involved with, play an influential role in the process.

The health and decisions of individuals may change over time, which is why Advance Care Plans should be reviewed regularly.

Advance Directives: What are they?

An invaluable part of Advance Care Planning is the completion of ‘Advance Directives’. A medical advance directive is a legally binding document that allows a person to refuse treatment. In legal terms, they are protected by the Mental Capacity Act. An advance directive does not empower patients to demand treatment; it simply allows them to refuse it. Nonetheless, people can include ‘statements of wishes’ within their advance care plans to tell healthcare providers what they would like in certain circumstances. Despite the fact that they are meaningful, statements of wishes are not legally enforceable.

Advance directives must be valid in order to be legally binding. It is essential that Advance Directives meet the following criteria in order to be valid:

• Persons making advance directives must be adults or over 18 years of age

• In order for an Advance Directive to be valid, the person must lack the capacity (as determined by the Mental Capacity Act) when the treatment is being given, but possess the capacity when the Advance Directive is made.

• Advance Directives were made in accordance with the person’s informed consent

• There must be a specific stipulation in the directive regarding the type of treatment to be refused as well as the circumstances under which it should be denied

• As long as the person with the power to make the directive is still capable of making it, they haven’t withdrawn it

• Following the directive made by the person who issued it, no legal attorney has been appointed to make the decision

A life-saving treatment advance directive must be in writing and witnessed. It is illegal to refuse basic necessities such as food, shelter, and warmth through advance directives.

Benefits and drawbacks of advance care planning

BENEFITS of advance care planning:

• Allows patients to make their own choices and respects their autonomy

• We encourage openness and forward planning

• Indicates the wishes of people who are unable to express themselves

• Law protects the right of the patient to refuse treatment

• Patients are less anxious about unwanted treatments

DRAWBACKS of advance care planning:

• A patient’s opinions can change over time, making it difficult to determine whether their advance care plan, which includes advance directives, is still valid.

• The patient may not realize exactly how the advance directive process works- they may not be aware of the exact circumstances in which they made advance directives.

• In regard to advance directives, the possibility of coercion exists

• There is a possibility that the diagnosis is incorrect

Summary

Watch the video below to understand what Advance Care Planning is all about. We discuss several practical aspects of this approach for patients nearing the end of their lives.

The video is courtesy of Health Quality and Safety Commission New Zealand.