title: Failure of the Current Advance Care Planning Paradigm: Advocating for a Communications-Based Approach.
abstract: The purpose of advance care planning (ACP) is to allow an individual to maintain autonomy in end-of-life (EOL) medical decision-making even when incapacitated by disease or terminal illness. The intersection of EOL medical technology, ethics of EOL care, and state and federal law has driven the development of the legal framework for advance directives (ADs). However, from an ethical perspective the current legal framework is inadequate to make ADs an effective EOL planning tool. One response to this flawed AD process has been the development of Physician Orders for Life Sustaining Treatment (POLST). POLST has been described as a paradigm shift to address the inadequacies of ADs. However, POLST has failed to bridge the gap between patients and their autonomous, preferred EOL care decisions. Analysis of ADs and POLST reveals that future policy should focus on a communications-based approach to ACP that emphasizes ongoing interactions between healthcare providers and patients to optimize EOL medical care to the individual patient.
authors.affiliation: Department of Emergency Medicine, Drexel University College of Medicine, 245 N 15th St. NCB Suite 2108, Mail Stop #1011, Philadelphia, PA, 19102, USA. laura.vearrier@drexelmed.edu.
authors.forename: Laura
authors.initials: L
authors.lastname: Vearrier
mesh_terms: D032722:Advance Care Planning / Q000592:standards*; D016223:Advance Directives / Q000331:legislation & jurisprudence; D002961:Civil Rights / Q000941:ethics*; D000066491:Clinical Decision-Making / Q000379:methods*; D003142:Communication; D006801:Humans; D026684:Personal Autonomy; D013727:Terminal Care / Q000331:legislation & jurisprudence
keywords: Advance care planning; Advance directives; Bioethics; Cardiopulmonary resuscitation; Decision making; End of life care; Health communication; Informed consent; Life support care; Living wills; Medical jurisprudence; POLST; Palliative care; Physician orders for life-sustaining treatment; Resuscitation orders; Terminal care