Advance Care Planning
A voluntary process of discussion and review to help an individual who has capacity anticipate how their condition may affect them in the future. Its main purpose and value lie in the ability to gain acceptance for making in-the-moment decisions which may have to deviate from what was once hoped for.
The main outcomes of this process are:
A verbal or written Advance Statement
A written ADRT
An Advance Statement allows a patient to document if they wish, any preferences they may have about their future care, and the things that may concern or worry them. This document can then be of help in informing decisions that may need to be made at a future time when the patient no longer has capacity to be involved in discussions. An Advance Statement is not legally binding. (The document can be found here)
Further information can be found here is this guide called Planning for your future care
A formal Advance Decision to Refuse Treatment (ADRT) allows a patient to document which specific treatments they would not wish to receive in the future, again when they have lost capacity for this discussion. (The document can be found here)
An ADRT will be legally binding on doctors if it meets the following criteria:
1. A decision is in writing, signed, witnessed and the patient is aged 18 or over;
2. It includes a statement that the Advance Decision is to apply even if the patient’s life was at risk;
3. The Advance Decision has not been withdrawn;
4. The patient has not, since the Advance Decision was made, appointed a Lasting Power of Attorney to make decisions on their behalf;
5. The patient has not done anything clearly inconsistent with its terms;
6. The circumstances that have arisen match those envisaged in the Advance Decision to Refuse Treatment.
A patient with capacity can appoint a Lasting Power of Attorney (LPA) for finance or welfare or both, in order that this person can be involved in discussions about future care. The role of an LPA is to inform any best interests’ decisions that a clinician makes for a patient who lacks capacity. Clinical responsibility continues to rest with the clinical team, not with the LPA.
Four questions that can be helpful in beginning the process/discussions are:
· Thinking about your condition/health, how are you feeling about what has been happening to you?
· Have you had any thoughts about your care, such as what you would like or not like to happen in the future?
· Have you named anyone else who you would like to become involved if it gets difficult for you to make a decision?
· If you became more ill, what sort of treatment would you like, or importantly, not like?