The Limits of Advance Care Planning

by Michael Pottash (@mpottash)Several luminaries of palliative care – writing in the Journal of the American Medical Association– recently outlined a strong case against advance care planning, referring specifically to advance directives and the efforts to plan for a future illness state. Planning for the end of life and documenting preferences was meant to improve “goal-concordant care” by providing a road map of a pe rson’s wishes for the end of their life when they can no longer communicate for themselves.When the Unitde States Supreme Court ruled against the family of Nancy Cruzan, they effectively placed a limit on the right to refuse medical treatment for those unable to speak for themselves, declaring that while there may be a “right to die” even for an incapacitated patient, the state may require clear evidence to overrule its interest in the sanctity of life. In addition to the changing legal landscape came our growing anxieties around medical technology and its encroachment on the boundary between life and death. W e have become enamored by the idea that clearly documented preferences, whether in a legal document or in a medical chart, could save us from some future purgatory between life and death.As the advance directive industrial complex grew, it soon became en vogue to claim that the ubiquitous completion of these documents could even curb healthcare spending. The common wisdom became: 1) people don ’t want aggressive medical interventions at th...
Source: Pallimed: A Hospice and Palliative Medicine Blog - Category: Palliative Care Tags: acp advance care planning pottash Source Type: blogs