1 / 24

Advance Care Planning

Advance Care Planning. Dr Regina McQuillan FRCPI. What is planned?. Why? Who? How? When? Where?. Advance Care Planning.

mcclainl
Download Presentation

Advance Care Planning

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Advance Care Planning Dr Regina McQuillan FRCPI

  2. What is planned? • Why? • Who? • How? • When? • Where?

  3. Advance Care Planning • Decisions made now, in anticipation of changing health status, when it is expected the patient or decision makers will not be in a position to make the same carefully reasoned decision.

  4. What is planned? • Level of intervention for investigation or treatment • Place of care • Place of residence

  5. Interventions - General • Hospital transfer • Intravenous antibiotics • Intravenous fluids • Subcutaneous fluids • Gastrostomy (PEG or RIG) • Ventilation

  6. Interventions - Specific • To address likely outcomes of particular illness

  7. Motor Neurone Disease • Gastrostomy • Non-Invasive ventilation (NIPPY) • Invasive ventilation

  8. Implanted Cardiac Debrillators • Switching off

  9. Chronic Obstructive Pulmonary Disease • Ventilation • ICU

  10. Dementia • Tube Feeding • Intravenous Antibiotics • Hospital Admission

  11. Why engage in Advance Care Planning? • Appropriate planned decisions

  12. Why engage in Advance Care Planning? • No legal or ethical obligation to provide all possible treatment • No obligation to provide futile treatment • Patient has the right to refuse treatment, even if life prolonging.

  13. Who makes the plan? • Patient • Doctor • Multidisciplinary Team • Family • Hospital Team

  14. Who makes the plan? • No one has the legal right or responsibility to make decisions about others health

  15. When should plan be made? • Dependent on illness – natural history • Changes in health status – eg hospital/nursing home admission • Markers of deteriorating health

  16. Where should plan be made? • Place of care • May be by joint, if patient moves from one care setting to another

  17. How should plan be made? • Most Important

  18. How should plan be made? If patient not competent - Doctor makes decision, in best interest of the patient, taking the known wishes and values of the patient into account, following wide consultation with family and the multidisciplinary team.

  19. How should plan be made? • May be done in stages • Rarely emergency or urgent

  20. How should plan be made? • Clearly documented • Consider ‘transfer document’

  21. How should plan be made? • Reviewed as health status changes

  22. Scope of Advance Care Plans • Must be legal

  23. Scope of Advance Care Plans • Must be ethical - respect the autonomony of others - cannot require family to give all care, cannot require health care workers to treat patient unethically - respect distributive justice

  24. Resources • www.bioethics.ie •  www.resus.org/pages/dnar.htm • www.endoflifecareforadults.nhs.uk

More Related