The Underappreciated Role of Advance Directives: How the Pandemic Revitalises Advance Care Planning Actions

Abstract

Covid-19 continues to alter our way of living and dying. Much attention has focused on how to resolve pressing issues surrounding resource allocation and competing public health ethics. While these are important discussions, the legal and ethical dilemmas of treatment decisions remain highly critical. The urgency to ensure that life and death affairs are in order is magnified due to the possibility of becoming infected with Covid-19. However, many people continue to face challenges in organising their future medical care and treatment. This article explores how the pandemic affects advance care planning through the lenses of law and ethics. The range of Covid-19 implications on advance care planning demonstrates a paradigm shift from a primarily elective function to an essential role in healthcare delivery. This renewed appreciation to advance care planning offers the opportunity to support and sustain the important role that it could play during ordinary and extraordinary times.

Occurrence of Advance Care Planning and Hospital Course in Patients Admitted for Coronavirus Disease 2019 (COVID-19) During the Pandemic

“… 19 - 23 However, despite the overwhelming consensus on their necessary roles during the COVID-19 pandemic, the rates of ACP for patients admitted for COVID-19 remains understudied. 6 , 8 , 24 - 26 …”

“…[19][20][21][22][23] However, despite the overwhelming consensus on their necessary roles during the COVID-19 pandemic, the rates of ACP for patients admitted for COVID-19 remains understudied. 6,8,[24][25][26] In the setting of the acute risk for death, rapid deterioration, and poor outcomes related to COVID-19, ACP has become more important than ever in patients admitted to the hospital. This pandemic has highlighted the importance of understanding and documenting patients' personal goals, values, and future medical care preferences.…”

Advanced Care Planning (ACP) in the early phase of COVID-19: A rapid review of the practice and policy lessons learned

“…Three studies noted that comprehension of ACP forms is influenced by health and literacy levels (Janssen et al, 2020; Lin et al, 2020; Selman et al, 2020), supported by several commentaries (Block, Smith, et al, 2020; Hughes & Vernon, 2021; McAfee et al, 2020; Paladino et al, 2021; Wallace et al, 2020; Xu et al, 2021). A rapid review identified an inverse relationship between ACP and socioeconomic status (SES) (West et al, 2021); with lack of trust in the healthcare system a point echoed in the commentaries (Chan, 2020; West et al, 2021).…”

“…Families may also experience communication difficulties. Several commentators reported on family values, perceptions and understandings that differ from those of clinicians (Ballantyne et al, 2020; Chan et al, 2021; Chan,2020; Fausto et al, 2020; Hopkins et al, 2020; Moore et al, 2020).…”

“…ACP laws and guidelines differ across countries and jurisdictions. Difficulties range from accessing lawyers (Chan, 2020), to differing legal terminology (Block, Smith, et al, 2020), to identifying who is entitled to initiate conversations. In some jurisdictions, only medical staff may initiate ACP conversations, with limited/no input from other multidisciplinary team members (Raftery et al, 2020; Singh et al, 2021).…”