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Advance care planning

We should all have discussions with the people that we love about what our wishes are if we were to have a catastrophic accident or lose capacity or have a life limiting disease and we should have these conversations with our families about their wishes but we don’t.

In fact the experiences of many of the people we care for professionally and their loved ones is that they do not get the opportunity to have frank and open discussions about their wishes as they approach the end of life. 

If we were more proactive in these discussions then they would be less distressing and could be held over a number of different conversations so that gradually a picture is built up from which the person and those important to them as well as the professionals involved in their care can put together a plan that can be shared with all the relevant people as to what their wishes are as they approach the end of life.

Many of us do not have a will, do not have a Lasting Power of Attorney for our parents or for ourselves, do not have advanced decisions to refuse treatment or any other advanced care plan which, if something does happen unexpectedly or otherwise we struggle to know what to do. The following resources may be of help in initiating the discussions and give some context to the importance of carrying out timely and sensitive conversations with people.

Resuscitation guidelines

Resuscitation Council UK. 2021 Resuscitation guidelines

Joint guidance from the BMA, Resuscitation Council (UK) and Royal College of Nursing (RCN). Decisions relating to CPR (cardiopulmonary resuscitation). Decisions about CPR – including decisions not to attempt CPR.

Advance care planning resources

Compassion in Dying - advance decision making. Anyone can write an Advance Decision but Compassion in Dying provides free forms that meet all the criteria needed for it to be legally binding. 
 DNR guidance - DNRs, DNARs, and DNACPRs are all abbreviations referring to an advance decision made by medical staff not to attempt cardiopulmonary resuscitation (CPR) on a patient who has stopped breathing, or whose heart has stopped. In more medical terms, when a person is suffering respiratory and/or cardiac arrest. It is important that you know how these decisions are made so you can have informed discussions with your healthcare professionals, and hopefully reach an agreed decision.
Office of the Public Guardian. Information on lasting power of attorney and mental capacity.
ReSPECT is a process that creates personalised recommendations for a person’s clinical care in a future emergency in which they are unable to make or express choices. 
RCN (2022). Adult Safeguarding: Roles and Competencies for Health Care Staff. One of the most important principles of safeguarding is that it is everyone’s responsibility. Health care staff frequently work with people in their moments of greatest need and can witness health and social inequalities which have a direct impact on the lives of people they care for. This intercollegiate document has been designed to guide professionals and the teams they work with to identify the competencies they need in order to support individuals to receive personalised and culturally sensitive safeguarding. It sets out minimum training requirements along with education and training principles.

Page last updated - 28/05/2024