dvanced care planning is an opportunity to give more specific direction about end of life decisions, beyond a living will. The problem with a living will is that the language specifies that in order for the document to be activated, the individual must be in a state of permanent unconsciousness, such as a permanent coma or persistent vegetative state, and there is no realistic hope of significant recovery.

Many individuals are living in the community or in a nursing facility that have chronic long-term health problems, are not competent, and may experience a health care crisis that leaves family and health care professionals facing decisions that are not specific to a living will. The following case study will make it clear why advanced care planning
is necessary.

John Smith is 88 years old. He suffered a stroke 5 years ago and was left paralyzed on his left side. Because his family could not care for him at home, he entered a nursing facility where he has lived for the past five years. Besides his paraplegia, he has been otherwise healthy, but has become increasingly confused over the past few years. John has expressed many times to his family that he wishes he would have died when he had his stroke. He resents living in a nursing home and needing others to care for him. John contracts pneumonia over a weekend. His family can’t be reached by the nursing home staff, and his attending physician is on vacation. The physician on call makes a judgment call to have him sent to the hospital to be treated. He recovers, but when his family is finally reached, they are upset, knowing that John would not have wanted to be treated.

Advanced care planning provides clear communication about what your end-of-life treatment decisions are.