Consent guidance: Advance care planning

1. 57. If a patient:
   
   
   1. a. has a condition that will affect the length or quality of their life, or
   2. b. has a condition that will impair their capacity as it progresses, such as dementia, or
   3. c. is otherwise facing a situation in which loss or impairment of capacity is a foreseeable possibility

1. you should encourage them to think about what they might want for themselves in the event that they cannot make their own decisions, and to discuss their wishes and concerns with you and the healthcare team.
2. 58. Such discussions might cover:
   
   
   1. a. the patient’s wishes, preferences or fears in relation to their future care, including any treatments they would want to refuse, and under what circumstances
   2. b. the feelings, beliefs or values that may be influencing the patient’s preferences and decisions
   3. c. the relatives, friends, carers or representatives that the patient would like to be involved in decisions about their care
   4. d. interventions that are likely to become necessary in an emergency, such as cardio-pulmonary resuscitation (CPR).
3. 59. You should approach such discussions sensitively. If the patient agrees, you should consider involving other members of the healthcare team, people who are close to the patient or an advocate.
4. 60. If a patient wants to nominate someone to make decisions on their behalf if they lose capacity, or if they want to refuse a particular treatment, you should explain that there may be ways to formalise these wishes and recommend that they get independent advice on how to do this.
5. 61. You must record the discussion and any decisions the patient makes. You should make sure that a record of the plan is made available to the patient and others involved in their care, so that everyone is clear about what has been agreed. This is particularly important if the patient has made an advance decision to refuse treatment.¹¹ You should bear in mind that care plans need to be reviewed and updated as the situation or the patient’s views change.