What Doctors Need to Know about Advance Care Planning

Lonny Rosen was recently asked by the Medical Post to provide his Top 5 Tips for physicians relating to advance care planning. Here they are:

1. Remember, a capable person must give or refuse consent to his or her own treatment. If the patient is capable, there’s no need to look at an advance-care plan to seek the consent of anyone else.

2. If a person is incapable, obtain consent to treatment from the highest-ranking substitute decision-maker (SDM), but only after providing all of the information necessary for the person to give informed consent, and answering all questions.

3. If the incapable person has prepared an advance-care plan, that plan is to guide the person’s SDM, not the doctor.

4. Guide SDMs in giving or refusing consent on behalf of an incapable person by asking them: Did the person express a wish that is applicable to the circumstances? If so, that wish must be followed, regardless of the SDM’s or your view as to what is best for the patient. If not, the consent must be given or refused in accordance with a person’s best interests.

5. Assist the SDM to determine what is in the incapable person’s best interests by looking at the person’s values and beliefs and the impact of the treatment proposed.In an Advocate Daily Article, Lonny commented further on the difference between wishes expressed by a person while capable and consent given by an SDM on behalf of an incapable person, noting that a person cannot generally give informed consent in advance because the details around making a decision respecting treatment are subject to change. An exception to this is a case where a person has a disease where the progression is predictable. In those circumstances, some treatment decisions can be made in advance. But generally, advance-care planning involves a person discussing his or her values, beliefs and wishes with another person, who can, when necessary, make decisions on the person's behalf in accordance with his or her wishes.

For more information on advance care planning, see this excellent guide to advance care planning in Ontario.