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Addressing criticisms of advance care planning

Criticisms of advanced care planning (ACP) have emerged from diverse sectors with an interest in end-of-life decision-making, raising concerns about the value of and approach to ACP, but Toronto health lawyer Lonny Rosen writes in the Canadian Bar Association health section newsletter that ACP is valued by patients and health-care providers alike as a means by which people can ensure they receive the care they want.

Advance care planning  is a process through which a person can make decisions regarding future health and/or personal care in the event that he or she becomes incapable of consenting to or refusing treatment or other care.

A variety of stakeholders have expressed concern and criticized the current state of advanced care planning, Rosen writes in the article, “advocates for vulnerable individuals, advocates for the elderly, and even health-care providers have expressed concern with various aspects of advanced care planning.”

But the concerns, he writes, “Largely relate to the manner in which ACP is undertaken and the use that is made of ACP documents”. ACP, if done correctly, permits people to give their decision-makers the comfort of knowing their wishes, values and beliefs and letting these guide the health-care decisions they make on behalf of the person.

With greater awareness of ACP, through campaigns such as Speak Up, Rosen writes, “people will regularly discuss with their loved ones what type of care they wish to receive and in what circumstances."

The article outlines the challenges brought forward by a number of stakeholder groups and addresses each one individually. Rosen, partner with Rosen Sunshine LLP, addresses challenges like how health-care providers may seek to take directions from ACP documents, rather than from a substitute decision maker:

“Except in provinces that permit personal directives that include wishes or instructions to override consent discussions, informed consent cannot generally be given in advance,” Rosen writes in the article. “This is because in Ontario and other provinces with similar legislative schemes, the law governing consent to treatment requires that a person be given information regarding the risks and benefits of treatment and the consequences of not having the treatment. Without knowing a person’s condition at the time treatment is proposed, a person or his or her substitute decision maker (SDM) will not be able to make an informed decision.”

Rosen also addresses a number of other concerns like how institutions sometimes require individuals to complete ACP forms ahead of time, and how ACP forms are sometimes prepared without sufficient information. Rosen suggests that this challenge be addressed through, “a more generalized approach to ACP, whereby the person identifies and discusses their values with their loved ones, especially their SDM. They can also identify the type of interventions they may wish to have in certain circumstances, and more significantly, the goals of such interventions. A process in which the person can explore and identify these issues will result in the development of ACP documents that are of assistance regardless of the state of the person’s health,” he writes in the article.

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