Does Advance Care Planning Improve End-of-Life Care

In recent years, some experts have spoken out against advance care planning such as living wills, saying they do not actually improve outcomes for end-of-life care. One article, entitled “What’s Wrong with Advance Care Planning,” was published in the Journal of the American Medical Association and stated, “[Advance Care Planning] does not improve end-of-life care, nor does its documentation serve as a reliable and valid quality indicator of an end-of-life discussion.”

Of course, not every expert agrees with this assertion. Articles like the one mentioned above have received a great deal of pushback from those in the medical and legal fields. They point to instances in which advance care planning documents have prevented a patient’s prolonged suffering. They have also highlighted the sense of comfort and peace of mind many patients experience when going through the advance care planning process.

Will Advance Care Planning Documents Affect Medical Decision-Making?

Detractors have said advance care planning does not affect end-of-life care because medical practitioners often do not follow these directives, or the documents may not be readily available when decisions need to be made. While this may be true in some cases, it is better to have legal documentation of your wishes than not. 

In one case, Cruzan vs. Director, Missouri Department of Health, the parents of a 25-year-old car accident victim petitioned the courts to remove her feeding tube. After several years of persistent unconsciousness, the parents felt it was time to end her suffering, but the hospital refused to do so. Ultimately, the Supreme Court upheld the hospital’s decision to continue life-extending treatment indefinitely. Their reason for this decision? The plaintiff did not have “clear and compelling evidence” of the incapacitated person’s wishes on this matter. A living will would have provided documentation of the patient’s wishes that the hospital would have been compelled to follow.

The Psychological Effect of Advance Care Planning

Whether or not advance care planning improves end-of-life care, its supporters say the psychological effect of planning on terminally ill patients cannot be discounted.

“Advance care planning has evolved significantly in the last decade, and the focus today is on conversations between patients and clinicians about patients’ goals and values, not about completing documents,” said Rebecca Sudore, director of the Innovation and Implementation Center in Aging and Palliative Care at the University of California-San Francisco.

Sudore and other like-minded experts contend that having these conversations with seriously ill patients reduces anxiety and gives them a feeling that they have more control over their care. These conversations also better prepare them to communicate with their families and medical personnel about their wishes.

Elder Law and Advance Care Planning

If you are interested in making your wishes known regarding life support and other medical decisions, speaking to a trusted elder law attorney is the first step. Robert Slutsky has served Pennsylvania residents as an elder care attorney in Montgomery County, PA and neighboring counties for decades, and he can help you write a living will or other advance directive.

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