Improving Medical-Legal Advance Care Planning. 2020

Sarah Hooper, and Charles P Sabatino, and Rebecca L Sudore
UCSF/UC Hastings Consortium on Law, Science & Health Policy, Medical-Legal Partnership for Seniors, Atlantic Institute, San Francisco, California, USA. Electronic address: hoopers@uchastings.edu.

The importance of advance care planning (ACP) has been increasingly recognized by health systems. However, 46%-76% of patients report engaging in ACP with lawyers, whereas only a minority report doing so with physicians. In the U.S., ACP with lawyers focuses on advance directive documents, naturally occurs outside of health care contexts, and is often uninformed by the clinical context, such as one's prognosis and clinical trajectory. These forms are regularly stored at home or at a lawyer's office and not available at the bedside when needed in a medical crisis. Yet, in contrast to clinicians, lawyers hold sophisticated knowledge about their states' advance directive law. Lawyers may also understand clients' socioeconomic context and plans more broadly, which are known to be critical for contextualizing and personalizing patient care but are often not well captured in health care. Aligning medical and legal approaches to ACP is important to ensuring the quality and value of those efforts. As an important first step toward this goal, we convened an interprofessional panel of medical and legal experts to elucidate the state of medical-legal ACP and begin to identify strategies to improve and align practices within and across professions. This article describes the historical disconnects between the medical and legal practice of ACP, recommendations and products of the interprofessional panel, and recommendations for future medical-legal collaboration.

UI MeSH Term Description Entries
D010820 Physicians Individuals licensed to practice medicine. Physician
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D016223 Advance Directives Declarations by patients, made in advance of a situation in which they may be incompetent to decide about their own care, stating their treatment preferences or authorizing a third party to make decisions for them. (Bioethics Thesaurus) Health Care Power of Attorney,Medical Power of Attorney,Healthcare Power of Attorney,Psychiatric Wills,Ulysses Contracts,Advance Directive,Attorney Healthcare Power,Attorney Medical Power,Contract, Ulysses,Contracts, Ulysses,Directive, Advance,Directives, Advance,Psychiatric Will,Ulysses Contract,Will, Psychiatric,Wills, Psychiatric
D032722 Advance Care Planning Discussions with patients and/or their representatives about the goals and desired direction of the patient's care, particularly end-of-life care, in the event that the patient is or becomes incompetent to make decisions. Advance Health Care Planning,Advance Medical Planning,Medical Planning, Advance,Planning, Advance Medical

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