Tips for Advance Care Planning

Lonny Rosen was interviewed recently by the Medical Post (available to subscribers only) about advance care planning in Ontario.

In the articles, we offered our Top 5 Tips for Physicians around Advance Care Planning:

1. If a patient is capable, he or she must give or refuse consent to treatment. Any advance care plan that the person may have prepared has no relevance to the decision to give or refuse consent.

2. If a person is incapable, his or her highest-ranking substitute decision-maker (SDM) must give or refuse consent on the patient's behalf. That SDM must be given all of the information necessary to give informed consent, and all of his or her questions must be answered for the consent to be informed and valid.

3. The SDM must give or refuse consent in accordance with any applicable wishes expressed by the patient while capable.  If the incapable person has prepared an advance-care plan, that plan is can guide the SDM; it "speaks" to the SDM, not the doctor.

4. Doctors who are seeking consent for treatment of their patient from an SDM should guide the SDMs in giving or refusing consent by asking them if the patient made an advance care plan or ever expressed a wish that is applicable to the circumstances. If so, that wish (rather than the SDM's or doctor's view about what is in the patient's best interests) governs the SDM's consent decision. If the patient never made a wish or advance care plan, the SDM must give or refuse consent in accordance with a patient's best interests.

5. Doctors should 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.