From Legal Documents to Patient-Oriented Processes: The Evolution of Advance Care Planning

Abstract

In 2004, Fagerlin and Schneider argued in their article “Enough. The failure of the living will” that, so far, policies on advance directives had failed to reach their goal—ensuring that patients’ wishes are known and respected and improving end-of-life care. As the recent development of advance care planning demonstrates, this failure was not due to advance directives being unimportant or surrogate decision-making impossible. It was due to the fact that planning ahead for fundamental life decisions cannot succeed without supporting communication, documentation and implementation. Advance care planning facilitates the shift from static, legal document-based views of advance directives and end-of-life plans to well-structured and patient-oriented processes. As evidence shows, best-practice advance care planning programmes can significantly improve end-of-life care; support patients, their caregivers and loved ones; ensure that wishes are known and respected; and increase health professionals’ assurance of doing the right thing. They can even contribute to lowering costs, while protecting patients from non-beneficial life-sustaining treatments.