Advance Care Planning Flashcards
Advantages of advance care planning?
- avoids conflict between Dr and relatives
- helps to determine course of action if a patient does not have capacity
- helps with safe access to care and continuity of delivery
What should an ACP discussion include?
Patients wishes, preferences, fears about treatment
Their feelings+ any beliefs and values
Family members + legal proxies present
Must include interventions in case of emergency such as CPR
A record of the discussion must be made
Is ACP legally binding?
Not legally binding but is taken into account when deciding overall benefit when patient lacks capacity
Ethical issues with advance requests for treatment?
A patient may weigh up the risks and benefits differently to doctors involved
Patients may want treatment that HCPs do not think is appropriate
Potential for psychological harm if conflict arises
Are advance requests for treatment legally binding?
No
Dr isn’t required to give treatment - must be in patients best interests at the time
Must be able to justify if not followed
Can’t be ignored, must always be taken into account
Lasting power of attorney- why is it made and when?
Can be made for financial and or health & welfare decisions
Made when patient has capacity
What are the requirements for an LPA to be made
Patient and LPA must be over 18
LPA Must be registered with office of the public guardian
What is the purpose of an LPA?
LPA has legal authority to make decisions and must be consulted on behalf of patient
LPA decisions must be in patient best interests
Advance refusals for treatment are legally binding if …
Valid
Clearly applicable to patients current condition
Advance refusal for treatment are not valid if…
- patient has withdrawn advance decision since making it
- patient has created an LPA - they can consent/refuse treatment
- when patient had capacity they did anything inconsistent with advance decision
Ethical reasons to support advance refusal of treatment?
Patient autonomy- may otherwise be given a treatment they do not want
Quality of life concerns - best interest
What are the 3 types of advance decisions?
Advance requests for treatment
Advance refusal of treatment
DNACPR
Ethical reasons to support DNACPR?
Low success rate of CPR
CPR is invasive
Side effects of CPR
What are the requirements for advance refusals of treatment?
Patient 18 or over, patients under 18 cannot refuse
Patient had capacity when decision was made
Patient was informed and not coerced
Must state the exact treatment to be refused
Must set out circumstances
Can be oral or written
What is required for a patient to refuse life sustaining treatment?
Decision must be written, signed, witnessed and must specify that treatment is life sustaining and death could result from refusal
