Share
In the first episode of Kennedys' new Medical Law Matters podcast, Rob Tobin, Head of Medical Law at Kennedys, was joined by Dr Zoë Fritz, a Consultant in acute medicine who also undertakes research that includes exploring ways to make healthcare delivery and interaction more equitable and ethical.
In part one of a two-part series on advance care planning, discussion focuses on the basics of advance care planning, its importance and how it helps both patients and healthcare professionals make difficult but better decisions about their future. Here we provide an overview of three key areas of discussion during this first episode.
What do we mean by advance care planning?
Advance care planning is an umbrella term that can encompass anything that involves a patient or those close to them, thinking about what treatments or health outcomes they may want in the future. This would include the treatments and health outcomes they may want in the future when they have mental capacity, and equally in the event where they do not have mental capacity to make their own decisions. Advance care planning can relate to any treatment.
It is a way of thinking about, recording and communicating those thoughts, wishes, values and feelings so that other family members and healthcare professionals can respect them , helping them to know what is in the patient’s best interests.
Advance care planning can help prevent circumstances where medical professionals and the patient’s relatives are required to make uniformed assumptions. It can provide clarity in terms of what treatments a patient would and would not want, and avoids the withholding of treatments they might benefit from and giving treatment they would find overly burdensome.
Establishing a shared understanding between the patient and doctor
Advance care planning is a useful preparatory exercise for both the patient and the clinician.
It can help establish a shared understanding between the patient and clinician of matters the patient may have to think about and perhaps also provide an opportunity to discuss what their prognosis is and what to expect. What are the kind of things that could happen in the future? How should I be prepared for those? What might I need to make decisions about? Advance care planning can help facilitate those conversations and help take the emotional burden away from relatives in the future.
An advance care planning discussion with a patient can help protect both the doctor and the relatives from being in the morally uncomfortable situation of feeling they have to make a decision on treatment on someone's behalf when they are unsure if the patient would have made the same choice.
Consent and patient autonomy
The law in England and Wales, is clear that the clinician has to treat the patient in their best interests where a patient lacks mental capacity to make that decision for themself. This is very individualised and there is no one shape which fits all for best interests.
Where a patient has documented and perhaps revisited over a period of time, what they consider to be in their best interests, a medical practitioner can get a good sense of who that patient is.
These conversations need to be thorough and carefully thought through. An advance care planning or future care planning document could be something that is long and lovingly written over a long period. However, it is important not to let the perfect be the enemy of the good. Any documentation providing a general indication of what a patient values is helpful.
Listen to the full episode on our website, Spotify, Apple and Audible.
Healthcare