Life Narratives and Advance Care Planning

Abstract

Decision making in clinical practice has shifted from paternalism to the patient’s self-determination, and then to shared decision-making (SDM) which appears to be the standard currently． When patients’self-determination was the standard in the late 20th century, they had the right to make decisions on their own． However, this resulted in patients not making the best choices in many cases． SDM allows the patient, family members, and medical and care professionals to talk together, provide information to each other, and share any concerns in order to realize the best for the person, without leaving the person alone to take the role of exclusive decision maker． The patient and those involved in their treatment and care discuss what is best for the person, using evidencebased choices whenever possible, in terms of the person’s narrated life． These changes have implications for how to prepare for medical and social care at the end of life when the person is often in an uncommunicative condition． Advance care planning (ACP) has developed to compensate for the limitations of advance directives, which were devised in the era of patients’self-determination, and emphasize the importance of the dialogue process． Home medical care is carried out where the person spins their life narratives with their family, and appears to be the optimum location to conduct ACP． If ACP is performed appropriately, it can also help to care for the family, and also increase job satisfaction among healthcare professionals．