Elsevier

The Lancet

Volume 356, Issue 9242, 11 November 2000, Pages 1672-1676
The Lancet

Department of Ethics
Planning for the end of life

https://doi.org/10.1016/S0140-6736(00)03168-8Get rights and content

Section snippets

What should be the goal of advance care planning?

The original goal of the movement for advance care planning—from the perspective of ethicists and legal scholars—was to assist patients to make treatment decisions for the event of incapacity. However, from the patient's perspective, the primary goal of advance care planning is more commonly preparing for death and dying.12 People struggle to find ways to cope with death.2 Once a central ritual of social and religious life, death has been privatised, desacralised, hidden behind institutional

What should be the role of the AD form?

Advance care planning has commonly been conceptualised as an event, specifically making a set of decision, and AD forms were developed to document these decisions. However, an AD form is not the central or defining feature of advance care planning. Advance care planning is a process of communication, and AD forms are best viewed as an assisting device embedded in the advance care planning process.8, 11, 12 In an intervention designed to increase completion of AD forms among outpatients, 38% of

Which AD form is best for the patient?

Numerous AD forms have been developed by organisations, governments, and academics. Many of the forms we refer to in this paper may be accessed full-text on the internet (panel). Each form is different in important ways, but currently no detailed taxonomy of ADs exists. This taxonomy will be developed through the examination of four questions that a physician or other involved party might ask about them. Should it be an instruction or proxy directive? Should it be a detailed or non-detailed

First page preview

First page preview
Click to open first page preview

References (30)

  • S Ramsay

    International research agenda set for end-of-life care

    Lancet

    (1999)
  • PA Singer

    Disease-specific advance directives

    Lancet

    (1994)
  • Institute of Medicine

    Approaching death: improving care at the end-of-life

    (1977)
  • The SUPPORT principal investigators

    A controlled trial to improve care for seriously ill hospitalized patients: the study to understand prognoses and preferences for outcomes and risks of treatments (SUPPORT)

    JAMA

    (1995)
  • MZ Solomon et al.

    Decisions near the end-of-life: professional views on life-sustaining treatments

    Am J Pub Health

    (1993)
  • British Medical Association

    Withholding and withdrawing life prolonging medical treatment: guidance for decision making

    (1999)
  • British Medical Association

    Advance statements about medical treatment

    (1995)
  • JM Teno et al.

    Advance care planning: priorities for ethical and empirical research

    Hastings Center Report

    (1994)
  • LL Emanuel et al.

    Advance directives for medical care: a case for greater use

    N Engl J Med

    (1991)
  • FJ Landry et al.

    Increasing the use of advance directives in medical outpatients

    J Gen Intern Med

    (1997)
  • SH Miles et al.

    Advance end-of-life treatment planning

    Arch Intern Med

    (1996)
  • PA Singer et al.

    Reconceptualizing advance care planning from the patient's perspective

    Arch Intern Med

    (1998)
  • DK Martin et al.

    A new model of advance care planning: observations from people with HIV

    Arch Intern Med

    (1999)
  • LC Hanson et al.

    What is wrong with end-of-life care? opinions of bereaved family members

    J Am Geriatr Soc

    (1997)
  • DP Sulmasy et al.

    The accuracy of substituted judgments in patients with terminal diagnoses

    Ann Intern Med

    (1998)
  • Cited by (100)

    View all citing articles on Scopus

    P A Singer is supported by a Canadian Institutes of Health Research Investigator award.

    View full text