Ethical principles involved in care of dying patients, particularly in relation to - advanced care directives

What an ACD is

Advance care directives (ACDs) document a person's wishes about future medical treatment, made while they had capacity, to guide care once they can no longer express those wishes themselves - a central tool for respecting patient autonomy at the end of life
Increasingly encouraged as part of routine advance care planning, particularly for patients with progressive/life-limiting illness, though completion rates remain lower than ideal across the general population

An ACD extends the patient's autonomy forward in time, into a period when they can no longer exercise it directly - ethically, a validly made ACD carries the same authority as a contemporaneous decision made by a patient with capacity, and takes precedence over the preferences of family or a substitute decision-maker where it validly applies to the situation at hand

Validity requires the ACD to have been made while the person had capacity, to be specific enough to apply to the actual clinical situation that has arisen, and (depending on jurisdiction) to meet specific formal requirements (witnessing, documentation format)
An ACD that is vague, outdated, or does not clearly address the specific situation at hand may not be directly applicable, requiring the treating team to fall back on substituted judgement/best interests principles instead

Locate and review any existing ACD early in the care of a patient with progressive illness, rather than only searching for one during an acute crisis when it is most needed and hardest to find
Encourage and support ACD completion as part of proactive advance care planning conversations, well before capacity is likely to be lost - not only once death is imminent

Substitute decision-making, guardianship, resuscitation status discussions, capacity assessment

An ACD is only useful if it can be found and applied at the point of need - a well-documented ACD that is inaccessible at the critical moment provides no more practical benefit than no ACD at all, underscoring the importance of accessible documentation across care settings

5 more sections, plus exam facts

Premium unlocks every note across every specialty, and the full exam fact library behind it.