Challenges in using advance care plans
When a patient has lost capacity to make health-related decisions and an advance care plan is available, healthcare professionals must consider whether it is valid. Examples of questions to consider are:
- Does it meet jurisdictional requirements?
- Does it reflect the patient’s current preferences?
Another consideration is whether the advance care plan is applicable to particular situations1. If an advance care plan does not cover a particular situation, the clinician should consult the patient’s substitute decision-maker. The general intent of the patient (including goals and values), if known, may help to inform the situation.
In some cases, an advance care plan will direct a healthcare professional to carry out treatment that is clearly not beneficial or is likely to cause harm that outweighs any benefit. A patient cannot demand a treatment that is clearly not beneficial; statutory law protects healthcare professionals who do not comply with an advance care plan in these circumstances. The situation should be discussed carefully with the patient’s substitute decision-maker, or a guardianship board (or equivalent) before such decisions are madeScott, 2013; for more information, see Substitute decision-making for patients with palliative care needs.