Advance care planning refers to an individual making decisions and arrangements relating to their future healthcare. Such planning is carried out in two ways—by appointing a substitute decision maker or by completing an advance care directive.

Substitute Decision Maker

The substitute decision maker is invested with making medical decisions for an individual only when the individual no longer has the capacity to make or communicate decisions for themselves. In the US, this substitute decision maker is referred to as a healthcare proxy.

Advance Care Directive

The advance care directive is a document outlining an individual’s healthcare preferences. The term usually refers to two kinds of legal documents—living wills and medical powers of attorney. These documents allow a person to give instructions about future medical care should they become unable to participate in medical decisions due to serious illness or incapacity. Each state regulates the use of advance directives differently.

There are advance care forms available for individuals to fill out, or the individual may write their own directives, which may include procedures or circumstances (life support, for example) that the individual would not accept. It’s advised that a doctor review and witness the advance care directive to make sure preferences and instructions are clear and based on informed decisions.

Benefits of Advance Care Planning

The purpose of advance care planning is to relieve anxiety and stress both for the individual and for family and loved ones by providing legal instructions relating to the individual’s future healthcare, including matters relating to end of life.

Advance care directives also benefit care providers. Research published in the Archives of Internal Medicine in 2009 noted that having a physician-reviewed, advance care directive in place results in lower costs and reduced utilization of aggressive care at the end of life.

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