Is There a Moral Obligation for Health Care Organizations to Develop Robust Advance Care Planning Programs?

Advance care planning (ACP) has become an integral part of patient care because of its ability to help guide treatment decision making for individuals in need of medical care but who have lost the ability to communicate—temporarily or permanently—due to illness or injury. Not all persons have the same treatment threshold; some persons value their lives above all else and will accept a high level of physical debility regardless of personal discomfort to stay alive. Others value their individual personal comfort over the length of their lives and will refuse otherwise life-sustaining treatment if they believe the treatment will cause them to sacrifice their comfort. The purpose of ACP is to help mentally capable adults express their individual goals, values, and treatment preferences prior to becoming unable to communicate so that medical providers and loved ones can make treatment decisions that best align with those adults’ wishes. When persons in need of medical care have not done ACP, medical providers and loved ones are left to guess what treatment decisions to make and may experience guilt or moral distress if they believe they have made the “wrong” choice. Not all ACP, however, is capable of bringing clarity to the treatment decision-making process. Simply asking persons to complete advance directives typically fails as a helpful treatment guide. ACP that occurs as part of a conversational process in which persons have the opportunity to reflect, understand, and make informed choices about their treatment preferences has a better chance of being useful in treatment decision making. This paper explores the ethical and legal foundations of ACP, demonstrates how robust ACP is superior to basic ACP, and argues that health care organizations have a moral obligation to develop robust ACP programs