Feature Article

Dying with dignity: the role of advance care planning

Roger M Clarnette
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Advances in medical technology have meant that an individual’s life may now be prolonged despite compromise of its quality. Autonomy is the major ethical principle of our healthcare system, but who has the right to decide what treatment should be given for patients with mental incapacity? This article presents a system of advance care planning that enables individuals to preserve their right to self-determination.

Key Points

  • Incompetent patients have rights. Advance care planning is a legally recognised mechanism for ensuring an individual’s wishes for treatment are considered.
  • For incompetent patients who are not in a life threatening situation, there is legislation in place that clearly recognises the right of family members to make treatment decisions.
  • Healthcare directives have no role in treatment decision making if a patient is still competent – that is, able to exercise autonomy.
  • The healthcare directive should not stand alone. If a patient is incompetent, treatment decisions arise from information in the directive and opinions of a nominated proxy and the doctor.
  • Patients will inevitably want to talk about healthcare directives as their use grows in Australia. GPs are in the best position to ensure individuals understand their choices.
  • GPs are likely to be responsible for making decisions in the event of a medical crisis, and must be willing to follow the instructions in a directive.