Thinking of an advanced care plan - Do it while you're well

Thinking of an advanced care plan - Do it while you're well

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EXPERTS have warned against the common practice of making an advance care plan while in hospital or immediately after a hospitalisation, when a recent illness or poor health experience could affect your decisions about future care.

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Brian Herd

Brian Herd

by KIRSTY STEIN

EXPERTS have warned against the common practice of making an advance care plan while in hospital or immediately after a hospitalisation, when a recent illness or poor health experience could affect your decisions about future care.

Australian Catholic University professor of ageing Tracey McDonald said people were being encouraged to make binding decisions when they were at their lowest point. “It’s just not fair, and quite often it’s rushed,” she said.

Melbourne hospital physician and writer Karen Hitchcock has urged mandatory reviews of the documents. “A monthly review does not seem too taxing, given that it is your life you would be registering,” she argues in Dear Life: On Caring for the Elderly published in Quarterly Essay.

She was concerned by the establishment of stand-alone advance care planning clinics at some hospitals, which meant planners could visit a patient on a referral from any doctor at a time when they were already vulnerable.

One crucial issue was many patients changing their minds about whether or not to undergo further treatment that would prolong their life once they were no longer sick.

If they did not amend the directive, Dr Hitchcock said, doctors were bound to abide by it the next time the person presented for treatment, even if the presentation was for an issue that could otherwise be addressed simply.

“There is a danger that we are not offering real choice – even if we believe we are – but merely securing acquiescence,” she said.

“I asked a woman who worked in one of these clinics interstate if the documents – signed, sealed and delivered to a patient’s electronic medical record – are ever reviewed.

“She looked confused and said ‘I guess they could be if the patient requested it’.

“Had she ever seen a patient more than once? She had not.”

Dr Hitchcock said people should have regular discussions with their doctor or attorney so directives reflect their changing values.

Brisbane elder law specialist Brian Herd said people should realise when making an advance care directive that it locked their health directions “into stone”.

“Those directions will be their directions forever unless they change their mind and the document,” he said.

“We strongly advocate to everyone we come into contact with that they should regularly review their life event documents – being their will, power of attorney and advance care directive.”

Mr Herd said his firm regularly wrote to clients reminding them to review their documents, but “it’s hard enough to get people to do these documents once, let alone twice”.

He said the final page of the advance care directive document facilitated its regular review, and included space to record when regular reviews had been undertaken.

■ For details on advance care planning go to www.myagedcare.gov.au

Thinking of an advance care plan? Do it while you’re well

THE Australian Medical Association strongly recommends people consider advance care planning in consultation with the family doctor.

AMA president Brian Owler said there was a real role for advance care directives in preventing futile treatment when people could no longer
speak for themselves.

“These are plans made by people when they’re well, when they’re able to make decisions,” he said.

Dr Owler said the decision to determine treatment was futile did not necessarily come down to age, “although elderly patients would be more frequently in this group”.

He said talking to the family and the family doctor about future treatment preferences, including choices such as surgery and chemotherapy,
was a good starting point.

The AMA recommends people make an advance care plan outlining clear preferences around health and personal care, preferred health outcomes and the goals and values that should be used to determine treatment decisions.

The federal government has invested in advance planning education in aged care through the DecisionAssist program.

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