Isaac Levi
Columbia University

"Advance Care Planning Isn't About "Getting It Right""

ABSTRACT: Much of the work on improving the process of advance care planning has run off the rails because of a misguided obsession with "getting it right," that is, with eliciting from patients their treatment preferences, or general values and philosophy of life, that will guide future decision makers in providing or limiting life-sustaining medical treatment. Despite the elaboration of ever more complex advance directive forms and conversational strategies, health care providers and families frequently end up frustrated and confused at the time decisions have to be made. Rather than defining success as "getting it right," I propose that we strive to create an environment in which patients and families have the chance to say things that matter to them in the face of critical illness or impending death. This is a patient-centered standard rather than a survivor-centered standard. It acknowledges that for many people the likelihood of death calls for reflection about ultimate things and expressions of meaning and hope. And some people may indeed construe meaning and hope as including efforts to direct their future medical care. Yet there would be no stigma attached to people who prefer not to talk about these things, as there is now when we say to them that without their participation we wonÕt be able to make the "right" decision.

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