Bioethics Topics: Advance Care Planning Advance Directives

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Bioethics TopicsAdvance Care PlanningAdvance
Directives
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I. Advance Care Planning

• How is advance care planning different from
  advance directive?
• What are the goals and expected outcomes of
  advance care planning?

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The goals of advance care planning are

• maximize the likelihood that medical care serves
  the patients goals
• minimize the likelihood of over-or undertreatment

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reduce the likelihood of conflicts between family
members (and close friends) and health care
providers

• minimize the burden of decision making family
  members or close friends

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Who should I approach for advance care planning?

• You should consider having a conversation about
  this with patients with the following conditions
• at risk for strokes (e.g., those with
  hypertension)

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experiencing early dementiaengaging in risky
behavior that is associated with head trauma and
coma (e.g., motorcyclists, riding in cars without
seat belts)
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experiencing severe, recurrent psychiatric
illnesses

• terminal illness

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When and where should I initiate advance care
planning?How can I raise these issues without
scaring patients?Are there some questions that
I could use for advance care planning?
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How should I advise a patient if she doesnt have
anyone to name as a proxy?How should I advise a
patient if he believes that some family members
with disagree with his wishes?As a trainee,
should I do advance care planning with my
patients?
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II. Advance Directives

• What types of advance directives are currently
  available?
• Why are advance directives important to medical
  care?
• Are advance directives legally binding?
• When should I refer to a patients advance
  directive?

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What if a patient changes her mind?What if the
family disagrees with a patients living
will?How should I interpret a patients advance
directive?What are the limitations of living
wills?