Advance Care Planning (ACP) is the term used to describe the conversation between an individual, their families and carers and those looking after them about their future wishes and priorities for care.  

It focuses on improving the care and support received for an individual nearing the end of their life so that they can live and die well in a place and manner of their choosing. This includes choices about treatments they choose to have and not to have. These will be documented. 

Advance Care Planning usually happens if someone has a serious illness but a person can plan ahead for future treatment and care at any time in their lives. It is a voluntary process. Planning ahead lets people know a dying person’s wishes and feelings while they are still able to make decisions and communicate these, which may not be the case during the later and last stages of dying.  

Letting family know about preferences and wishes could help if they ever have to make decisions about the care provided.

A documented Advance Care Plan will normally be made with a healthcare team when a person is nearing the end of their life and it will be attached to their medical notes or care plan.

 It is likely to include the following items:

1. Where a person wants to be cared for
2. Where a person would like die
3. Who a person would like to have with them at the end of life
4. Values and religious beliefs
5. Dietary requirements

Advance Care Plans are not the same as Advance Decisions or Living Wills.  

Advance Decisions or Living Wills allow a person to document treatments that they do not want to have in the future in case they become unable to make or communicate decisions about this themselves. 

People use Advance Decisions or Living Wills to refuse treatment like:

1. Cardiopulmonary resuscitation (CPR) if their heart stops.
2. Being put on a ventilator if they cannot breathe on their own.
3. Being given food or fluids artificially, for example through a drip, a tube through the nose or tube directly into the stomach.
4. Antibiotics for a life-threatening infection.

Advance Decisions cannot be used to:

• Ask for something illegal, such as assistance to end a person’s life.
• Refuse to be offered food and drink by mouth or to refuse care that keeps a person clean and comfortable. This is because these things are part of basic care, which healthcare professionals have a duty to provide.
• Choose someone else to decide about treatment on a person’s behalf. Choosing someone else to make decisions about a person’s health and care is done by making a Lasting Power of Attorney for Health and Welfare. 
• Demand certain treatments. This is because doctors don’t have to give a person treatment just because they ask for it. Doctors decide whether treatment is medically appropriate for a condition and then the person decides whether or not they want that treatment.

A Lasting Power of Attorney (LPA) for Health and Welfare allows a person to give someone else the legal power to make decisions on their behalf in case they later become unable to make decisions for themselves. 

An LPA can also cover decisions about money and property.

Advance Decision example:

Rafi Singh has been diagnosed with cancer.  Rafi knows he does not have long left to live.

Rafi wants to enjoy the time he has left with his friends and family. He has decided he does not want to have any more treatment even if it might give him a couple of extra months to live. He wants to spend his time building positive memories.

Rafi has talked to his doctor about the treatment that has been recommended and he has detailed this in an Advance Decision document. Rafi has talked to his family about this and has given them a copy. 

Rafi’s doctor and local hospital also have copies of the Advance Decision document so everyone involved in his end of life care and support is aware of his wishes under the Advance Decision which is legally binding.