Advanced Care Planning (ACP)

ACP involves discussing a patient’s future care in case they become incapacitated. Although ACP is not legally binding, it encompasses:

1. The patient’s understanding of their illness.
2. The patient’s wishes regarding future care.
3. Specific treatments or care the patient wishes to avoid.
4. Individuals the patient wants to be involved in their care.
5. Consideration of a legal Advance Decision to Refuse Treatment (ADRT).
6. Consideration of a Lasting Power of Attorney for Health.
7. Discussion about DNACPR (Do Not Attempt Cardiopulmonary Resuscitation) and life-sustaining treatments.

 

Advance Decision to Refuse Treatment (ADRT)

• An ADRT is legally binding and allows patients to refuse specific treatments, even if they are life-sustaining.
• However, patients can not demand treatments deemed inappropriate, futile, or harmful by the medical team.

 

An ADRT is valid if:

1. The patient is over 18 years old.
2. The patient had capacity when the ADRT was made.
3. The ADRT is signed and witnessed.
4. The ADRT applies to the current situation.
5. To remain valid, the patient must not have done or said anything to question its validity.
6. Fact: DNACPR & ReSPECT forms are not legally binding and are just strong recommendations for health care professionals in emergencies.

Finally, the ADRT can be seen as a continuation of ACP. Think of ADRT as the legally binding component of ACP.

 

Example, beginning a conversation about ACP & ADRT 

Background: Emma has stage 4 breast cancer and recently saw her GP regarding pain control. She experienced delirium and spent two weeks in the hospital, an experience she does not wish to repeat. She currently has recovered and has capacity, and there is no LPA for health.

 

Doctor: Emma, I understand you had a difficult time in the hospital recently with your chest infection and extended stay.

Emma: Yes, doctor, it was rough. I don’t want to go through that again.

 

Doctor: What did you find particularly hard to deal with, Emma?

Emma: It was horrible. I never wanted to go to the hospital, but no one listened. The paramedics took me because I was unwell, but I already knew that. I have cancer, and I don’t want to spend my time in the hospital.

 

Doctor: I understand, Emma. What might have happened if they hadn’t taken you to the hospital?

Emma: Yes, doctor, I might have died, but I’ve always known that. I don’t want to go to the hospital. I’m happy to take tablets at home, but nothing more.

 

Doctor: I can help you, Emma, by recording your wishes about treatments you want to avoid if you’re too unwell to speak for yourself. This is called advanced care planning (ACP). If you feel strongly about avoiding specific treatments, we can consider an Advance Decision to Refuse Treatment (ADRT), which is legally binding. What do you think?

Emma: I would really appreciate that, doctor.

 

Reference & More information:

• https://www.nhs.uk/conditions/end-of-life-care/planning-ahead/advance-decision-to-refuse-treatment/#:~:text=It%20lets%20your%20family%2C%20carers,some%20situations%2C%20but%20not%20others.
• https://cdn.compassionindying.org.uk/wp-content/uploads/advance-decision-pack-v2.3.pdf

 

Dr Sakaria Farah
PassCME SCA Tutor