Advanced Care Planning Flashcards
What is advance care planning?
Advance care planning (ACP) is a process of reflection, discussion & communication that enables a person to plan for their future medical treatment & other care, for a time when they are not competent to make, or communicate, decisions for themselves
What is advance care planning (in brief)?
Advance care planning (ACP) is a process or a plan that enables a person to plan for their future medical treatment & other care, when they are not competent to make decisions for themselves & help guide future care, how decisions are made or by whom
What are the fundamental principles of advance care planning (ACP)?
ACP is based on fundamental principles of:
- self-determination
- dignity
- avoidance of suffering
What are advance care directives (ACDs)?
Advance care directives are legally binding documents which provide a means for competent adults to record preferences for future health & personal care and/or instruct a substitute decision maker (SDM).
ACDs vary in name by state/territory.
What is Advance Care Directives (ACDs) called in every state of Australia?
ACT:
Health Direction
NSW:
Advance Care Directive
VIC:
Refusal of Treatment Certificate (RoTC)
or
Advance Care Plan
QLD:
Advance Health Directive
WA:
Advance Health Directive
TAS:
Advance Care Directive
When are advanced care directives (ACDs) are useful?
They only come into effect if the patient does not have the ability to make the treatment decision for him/herself
Why advance care directive (ACD) should be reviewed regularly? How often?
As available treatment options and patient circumstances are continually changing, ACDs should be reviewed regularly every 2 years for patients in good health & more frequently for patients who are not
(e.g. every 6 months if they are terminally ill)
What does the ACD in each state/territory of Australia cover in terms of future health plans?
NT, SA:
End-of-life medical decisions and/or terminal illness only
ACT:
Whether treatment can be withheld or withdrawn only
WA, QLD, TAS:
All/any future medical treatment wishes
VIC, NSW:
Will depend on which document is completed
What is an SDM?
An SDM (substitute decision maker) is the person who has the power to make decisions on another person’s behalf when that person has lost the capacity to do so.
The title will vary in name by state/territory.
Who can appoint the SDM for a person?
The SDM can be officially appointed by:
- the patient themselves
- a Court or Guardianship Board on the patient’s behalf
- When required, a medical practitioner can also identify an SDM on the patient’s behalf
Who should make the decisions In situations when there is no appointed SDM or ACD in place?
In cases of medical emergency:
the decisions about treatment may fall to the treating healthcare professional
In non-urgent situations:
the treating medical practitioner needs to obtain consent from the Person Responsible (Statutory Health Attorney)
Who are the Persons Responsible?
Person Responsible (Statutory Health Attorney) is identified, according to the hierarchy, by the treating medical practitioner when no SDM has been appointed by the patient & in the absence of an SDM appointment by the Court or Guardianship Board.
What is the principle of ‘Presumption of Capacity’?
Presumption of Capacity means a person is deemed to be competent unless there is good evidence that they are not.
This definition is accepted by the United Nations & the legislation throughout Australia.
Is a person with dementia considered competent to make treatment decisions according to principle of presumption of capacity?
A diagnosis of dementia in itself is not sufficient to prove that a patient has lost capacity as it will depend on the degree of cognitive impairment at the time the decisions are being made.
What will happen if a person who is considered to have capacity to make decision does not have the capacity?
The onus of proof is on the person who believes that their family member/relative/friend lacks capacity.
e.g. if someone makes what others think is a bad decision, this is not proof that the person has lost the capacity to make their own decisions!
What are the main criteria for the definitions of mental capacity a person must be able to?
- understand the facts involved in decisions
- know the main choices that exist
- weigh up the consequences of these choices & understand how the consequences affect them
- freely & voluntarily make a decision about the matter
- communicate their decision
In what situation ACPs are more beneficial?
- end-of-life care (the last 12 months): patients with terminal cancer or on dialysis
- terminal care (the last days to weeks of life)
- deteriorating illness in patients with a life-limiting progressive chronic disease, such as COPD
