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Are advance care plans of any value?

Recent papers in BMJ Support and Palliative Care concerning advance care plans (ACP) offer empirical evidence that helps us to understand how ACP are, and should be, applied.1 2 They are welcome and timely as critics often argue that palliative medicine sometimes values opinion over evidence.

However, even in medicine, some things do not need evidence as proof: indeed, their value may be clear despite the evidence. ACP is an example, properly done, it captures a unique narrative. Rationality and professionalism are the justification: personhood, respect for autonomy, confidentiality, consent are all inherent to healthcare.

The importance of ACP as a person’s narrative (and not just a quick reference for decision-making) is to protect them from being ‘done to’—the Liverpool Care …