Planning ahead for medical crises
Advance Care Planning is an instrument that enhances the autonomy of patients in severe, life-threatening illness. The LMU will host the 5th World Conference on the topic.
Advance Care Planning (ACP) is a new concept which includes active support for individuals to specify how they wish to be cared for in severe, life-threatening illness – even if they are incapable of communicating directly with their care-givers. The idea has now been incorporated into the draft text of a proposed law on Hospice and Palliative Care in Germany (which amends §132g SGB V) – and the 5th International Conference on ACP and End of Life Care will take place at LMU from September 09 to 12, 2015.
“Advance Care Planning is designed to help people to retain control over medical treatment in life-threatening illness. ACP creates a situation where the patient’s wishes – specifying the goals of treatment and the use of particular life-prolonging interventions under certain circumstances – can be respected, even when the patient is no longer able to articulate them,” says Professor Georg Marckmann, Director of the Institute for the Ethics, History and Theory of Medicine at LMU, and Chair of the upcoming Conference.
According to the current draft of a new law on Hospice and Palliative Care, the German sickness funds will provide financial support for ACP programs that offer individual counseling by qualified personnel for nursing home residents. “This is a mile-stone for the establishment of ACP in the German health care system,” says Marckmann. “Obviously, elderly people in nursing homes are among those who are most in need of such support. Until now, very often all available life-sustaining technologies are brought into play when an aged and incapacitated patient is taken to hospital, even though many of these patients might have objected to their use had they been able to choose. But in the longer term, ACP should not be seen as an issue that is restricted to the very old and chronically disabled. It makes also sense for younger people who are still in good health to consider advance care planning – for the event of a serious accident, for instance – and it can be recommended particularly to people in retirement age who may have reservations concerning the use of the whole battery of life-sustaining technologies under specific circumstances.”
Improving the current situation
ACP is intended to remedy the deficiencies of the current approach to arriving at advance directives in Germany. “The instrument of the advance directive as such has been legally defined and strengthened in 2009,” Marckmann explains. “But it is utilised by only a small proportion of the population, partly because people find the task of filling it out to be too taxing. The advance directive forms themselves are often imprecisely phrased, and the signed directive often cannot be located – and therefore cannot be taken into account – in an emergency. Moreover, for most lay-persons it is not transparent what situations they need to plan for, and what options they have in their planning.”
The concept of Advance Care Planning as originally developed in the United States envisages a process of communication regularly facilitated by specifically qualified health care staff, and involving close family wherever possible, which may culminate in the formulation of an individual advance directive. “The obvious place for such consultations is a regular visit at one’s family practitioner,” says Marckmann. ACP encourages the use of uniform, carefully designed advance directive forms that include passages with clear emergency instructions informing medical personnel how they should proceed in an emergency. Regional standards for the implementation of the directives must also be established, and a pilot project entitled “beizeiten begleiten” (Timely Guidance) carried out in North-Rhine-Westphalia has produced guidelines for the formulation of directives that significantly improve their clarity and effectiveness.
One of the aims of the Conference, which will be attended by more than 350 healthcare experts and policymakers from all over the world, is to outline the measures needed to set up the requisite framework for the implementation of Advance Care Planning on institutional, regional, and national scales. “As populations age, the incidence of dementia among the elderly will steadily rise, and with it the portion of elderly patients who are unable to make informed decisions in their final phase of life. This scenario underlines the growing social relevance of ACP,” says Marckmann.
For further information, see http://www.acpel2015.org/.