Clinical meaning
Advance care planning (ACP) is a process of understanding and sharing personal values, life goals, and preferences regarding future medical care. The Patient Self-Determination Act (1990) requires healthcare facilities to inform patients of their right to make healthcare decisions and execute advance directives. Advance directives include the living will (written instructions specifying desired treatments in specific situations, such as terminal illness or persistent vegetative state) and the durable power of attorney for healthcare (DPOA-HC)/healthcare proxy (designating a surrogate decision-maker authorized to make healthcare decisions when the patient lacks capacity). Decision-making capacity (clinical determination, not legal) requires four abilities: understanding (comprehending information), appreciation (applying information to one's situation), reasoning (weighing risks and benefits), and expressing a choice (communicating a consistent decision). Capacity is decision-specific and can fluctuate. Competency is a legal determination made by courts. When patients lack capacity and have no advance directive, surrogate decision-making follows a hierarchy: (1) substituted judgment (what the patient would have wanted based on known values and prior statements), (2) best interest standard (what a reasonable person would choose given the circumstances). POLST (Physician Orders...