New Incapacity Planning Legislation In Force in BC September 1, 2011

New Incapacity Planning Legislation In Force in BC September 1, 2011

Recognizing the Conversations

Advance Care Planning (ACP) conversations don’t typically appear with headings and paragraphs and categories. They appear in the midst of life – whether it be a brief aside during a movie, a comment about the importance of pets in our life, or significant words exchanged with family members during the healthcare crisis of another family member. These conversations can be short or long and can happen with individuals of any age or health status. Have a look at these statements – which of them fit into the category of ACP?
1. “This little dog is the best thing that ever happened to me. I often wonder how I got along without him.”
2. “I just can’t stand being in confined spaces.”
3. “Harry is in a nursing home now and they have to spoon feed him. Sheila cries every time she visits him – so much so that her kids wonder if they should limit her visits.”
4. “I think the idea of defibrillators in sports arenas is a great one. In fact, every time I go to a hockey game and pass the defibrillator on the wall, I feel good that help would be so close at hand.”
5. “I get the most pleasure out of seeing her smile and having her squeeze my hand.”
6. “I watched as her minister prayed with her. She seemed to get such comfort from that prayer. I hope someone will pray for me that way when I’m dying.”
7. “I have written out my wishes for future care on a piece of paper.”
Of course all of these comments have something to do with ACP. They communicate values and beliefs and concerns about health and general well-being. They aren’t legal documents, but they are important guidelines for delivering care to an individual when that individual is too ill to make decisions for themselves.
So let’s stop looking for formal conversations alone to guide us as we agree to treatment for and deliver care to our family members who can no longer decide for themselves. Let’s jot down snippets of conversations, let’s recall ways in which these individuals lived their lives, and let’s use this information to inform our decisions for them. The goal should be for us to do just what the person would have wanted us to do, in light of their values, goals, and beliefs.
Take a moment to view this brief commentary by Joanne Lynn, Bureau Chief for Chronic Diseases and Cancer in Community Health Administration of the Department of Health for Washington, DC. Joanne is a leader in ACP and sheds light on the breadth of these ACP conversations.
http://www.youtube.com/watch?v=OOH5hVQRxD4

June 2011 Advance Care Planning Conference

The Conference will be relevant to all health and social care professionals who are involved in advance care planning/end of life care and are committed to improving quality of care for patients. Delegates are invited from a wide range of backgrounds including end of life/palliative care, primary care, critical care, acute hospitals, care of the elderly, ethics and spirituality, policy development and social care.

Please Tell Me Why We Aren't Talking About Advance Care Planning

Have a look at the Respecting Choices website. A very powerful study that indicates the importance of advance care planning conversations.
Also, check out the August 2nd New Yorker for the article, Letting Go, by Atul Gawande. It's a long read for a magazine article, but it may be the most important piece you read this year. It refers to the work done at Gundersen Lutheran Hospital and the impact on the residents of La Crosse, Wisconsin. In the New Yorker article, Gawande comments on the perspective of many that death is the ultimate enemy and there is nothing reproachable in those who rage against it:

"I think of [this] every time I have a patient with a terminal illness. There is almost always a long tail of possibility, however thin. What's wrong with looking for it? Nothing, it seems to me, UNLESS it means we have failed to prepare for the outcome that's vastly more probable. The trouble is that we've built our medical system and culture around the long tail. We've created a multitrillion-dollar edifice for dispensing the medical equivalent of lottery tickets--and have only the rudiments of a system to prepare patients for the near-certainty that those tickets will not win. Hope is not a plan, but hope is our plan."

Impact of a Disease-Specific Advance Care Planning Intervention

I can hardly wait for the July 2010 publication of the Journal of the American Geriatrics Society.
The study that will be featured in this article by Kirchhoff, Hammes, Kehl, and Briggs contains data that demonstrate the striking effectiveness of the Respecting Choices® structured, patient-centered interview. The structured nature of the interview means that facilitators trained in its delivery can use the intervention with consistence and integrity. Please contact me for further information about this intervention.

Successful International Conference

The Melbourne Inaugural ACP Conference was an outstanding success. What a treat to be in the presence of such stellar healthcare leaders and to hear of the progress being made in the field of Advance Care Planning.

The speakers noted on the conference web page represented a broad range of clinical perspectives from around the world and delivered outstanding presentations.

The next international conference is being planned for London, England in June, 2011.

International ACP Conference - An Idea Whose Time Has Come

No longer a topic to be approached tentatively, fearing legal and ethical recriminations. Finally a topic to be incorporated into the everyday lives and health care of individuals--conversations to be initiated and honoured over time--a process, not an event. A fundamental human right: the right to express wishes about personal goals for future health care and have those wishes be durable through periods of decision-making incapacity. Advance Care Planning and the research supporting it will be the linchpin of the first ever International Conference on Advance Care Planning being held this April in Melbourne, Australia. International experts presenting in Melbourne include: Associate Professor W (Bill) Silvester
Austin Health, VIC (Chair)
Dr Bud Hammes
Ethicist and advance care planning expert, Wisconsin, USA
Ms Linda Briggs
Ethicist and advance care planning expert, Wisconsin, USA
Professor John Luce
Critical care and end-of-life care specialist, San Francisco, USA
Prof Malcolm Fisher AO
Intensive Care and end-of-life care specialist, Sydney, Australia
Ms Sue Grant RN, Dipl.T.
Advance care planning expert, Vancouver, Canada
Professor Jane Seymour
Palliative and end-of-life care expert, Nottingham, UK
Professor Keri Thomas
National Clinical Lead Palliative Care in the UK National Health Service End-of-life care program and Lead for the Gold Standards Framework program, Clinical Director Community Pall Care, Pan- Birmingham Palliative Care Network, Senior Clinical Lecturer Birmingham University, UK
Professor Pablo Simón Lorda
Advance care planning expert, Granada Spain
Professor Edwin C. Hui
Ethics and end-of-life care specialist, Hong Kong