Planning for what matters most to you

This week, 20 - 26 March 2023, is National Advanced Care Planning (ACP) Week. But what exactly is Advanced Care Planning?

Advanced care plans come into effect when you lose the capacity to make health decisions. Capacity is your ability to understand, retain and weigh up information as part of the decision-making process, and this includes understanding the consequences of a decision.

Engaging in advanced care planning (ACP) while you still have this capacity allows you to communicate your values, wishes and preferences in the event you become unable to communicate or make treatment decisions. It allows your loved ones and your healthcare team to provide respectful and dignified care, in alignment to what matters most to you.

We should care about advanced care planning now, because it is for the living.

Many people think of ACP as just legal documents, but it is so much more. It helps to visualise the planning process as a spectrum that we all exist on.

All of us have a 1 in 1 chance of dying – we don’t know when, but likely do have thoughts and feelings about the care we would like to receive in the lead up to death. This is the pre-contemplation phase.

Next one might engage an internal conversation in which you begin to question "What matters most to me? What might I want?" This is the self-reflection phase.

You then might be ready to discuss these thoughts with friends, family members, colleagues and your healthcare team. In giving a voice to this introspection, the discussion phase leads to the part of the spectrum where you can progress more in-depth conversations about your values and your goals and begin to enact your choices.

These discussions are then formalised with documents. In Queensland, 3 key documents comprise the ACP declaration process:

• Statement Of Choices – a non-legally binding statement of your preferences, signed by person and healthcare professional (preferably physician).
• Enduring Power of Attorney (EPOA), which appoints a substitute decision maker. Your EPOA will make decisions on your behalf if and when you lose capacity to do so. Appointing an EPOA requires the signing of 2 forms – one medical and one financial – by the person, and the nominated EPOA, witnessed by an authority such as a JP. These forms constitute legally binding documents.
• A legally binding Advance Health Directive (AHD), signed by the person, their physician and witnessed. It directs your substitute decision maker and medical team about your care preferences and wishes.

Whilst a will is a recommended step in making any end of life preparations, it is only enacted when you die. Advanced care planning is for when you are alive.

The two biggest misconceptions about ACP is that it is (1) only for older or elderly people, or (2) for those who have a life limiting illness. Advanced care planning is a process that can and should be undertaken by anyone over the age of 18 with capacity. Such important decisions are in fact best made when one is not under the stress of an unexpected or traumatic event, diagnoses or illness.

Once documents are completed, the feedback loop continues. Circumstances, people, technology and medical advancements change, and so too can your wishes and preferences over time – so our ACP conversations and related documents should also be maintained or reviewed over time.

This National Advanced Care Planning Week, take time to consider where you are on this spectrum of ACP reflection and take action to further your progress to the next planning phase – whether this means beginning to engage in inner dialogue, starting conversations with your family and healthcare team or completing documentation.