Volume 50, Issue 4 p. 761-767

Advance Care Planning by Proxy for Residents of Long-Term Care Facilities Who Lack Decision-Making Capacity

Ladislav Volicer MD, PhD

Ladislav Volicer MD, PhD

Geriatric Research, Education and Clinical Center, Dementia Study Unit, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts;

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Michael D. Cantor MD, JD

Michael D. Cantor MD, JD

The National Center for Ethics of the Veterans Health Administration, Washington, DC;

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Arthur R. Derse MD, JD

Arthur R. Derse MD, JD

Center for the Study of Bioethics and the Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin;

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Denise Murray Edwards RNCS, ARNP, MA, MEd, MTS

Denise Murray Edwards RNCS, ARNP, MA, MEd, MTS

The Center for Health and Well-Being, West Des Moines, Iowa;

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Angela M. Prudhomme JD

Angela M. Prudhomme JD

Office of the General Counsel of the Department of Veterans Affairs, Washington, DC;

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Dorothy C. Rasinski Gregory MD, JD

Dorothy C. Rasinski Gregory MD, JD

Retired VA

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James E. Reagan PhD

James E. Reagan PhD

The National Center for Ethics of the Veterans Health Administration, Washington, DC;

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James A. Tulsky MD

James A. Tulsky MD

The Center for Health Services Research in Primary Care, Durham Veterans Administration Medical Center, Durham, North Carolina.

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Ellen Fox MD

Ellen Fox MD

The National Center for Ethics of the Veterans Health Administration, Washington, DC;

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The National Ethics Committee of the Veterans Health Administration

The National Ethics Committee of the Veterans Health Administration

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First published: 08 May 2002
Citations: 43
Address correspondence to Ellen Fox, MD, Director, National Center for Ethics (10AE), VA Medical and Regional Office Center, 215 North Main St., White River Junction, VT 05009. E-mail: [email protected]

The views expressed in this article do not necessarily represent the views of the Department of Veterans Affairs or of the United States Government.

Abstract

This report examines whether long-term care facilities should implement policies and procedures to support advance care planning by proxy for residents who lack decision-making capacity. The report focuses on advance care planning in the Department of Veterans Affairs. After reviewing clinical, legal, and ethical perspectives, the authors conclude that advance proxy planning is ethically sound and can improve patient care. However, because experience with advance proxy planning is still fairly limited, the authors do not recommend that a particular standardized approach be mandated at the national level. Instead, local facilities are advised to develop their own policies and then evaluate their effect. The report contains specific recommendations for the advance proxy planning process.