Advance Care Planning
Linda L. Emanuel, MD, PhD;
Charles F. von Gunten, MD, PhD;
Frank D. Ferris, MD
Arch Fam Med. 2000;9:1181-1187.
Advance care planning is the process of planning for future medical care, particularly for the event when the patient is unable to make his or her own decisions. It should be a routine part of standard medical care and, when possible, conducted with the proxy decision maker present. It is helpful to think of the process as a stepwise approach. The steps include the appropriate introduction of the topic, structured discussions covering potential scenarios, documentation of preferences, periodic review and update of the directives, and application of the wishes when needed. The steps can be integrated flexibly into routine clinical encounters by the physician and other members of the health care team. The process fosters personal resolution for the patient, preparedness for the proxy, and effective teamwork for the professionals. The process also has pitfalls of which to be aware.
From the Project to Educate Physicians on End of Life Care, Interdisciplinary Program in Professionalism and Human Rights, and the Department of Medicine (Dr Emanuel), Northwestern University Medical School, Chicago, Ill; the Center for Palliative Studies (Drs von Gunten and Ferris), San Diego Hospice, and the Department of Medicine, School of Medicine, University of California, San Diego (Dr von Gunten); and the Department of Family and Community Medicine, University of Toronto, Toronto, Ontario (Dr Ferris).
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