Advance care planning is one of the hallmarks of palliative care. I strongly believe that such planning allows patients to choose care that is most congruent with their views on life. We frequently say to patients “Let’s hope for the best, but prepare for the worst.” – such planning allows patients to prepare, to consider scenarios based on their current health, their genetic make up, family history or philosophy toward health and illness to choose treatment options that will be most compatible with their wishes. I believe that an idea of “advanced care planning consultations” is excellent way to start the discussion that in many cases will continue throughout a patient’s life and illness.

Advance care planning has nothing to do with “rationing care” and calling it “death panels” is derogatory and preposterous. Recent study of patients with incurable, stage IV lung cancer showed that these patients, despite having very poor prognosis ( most of the patients with stage IV lung cancer live for about 6 months on average) had not had a discussion with their physician about hospice care (an example of advanced care planning). Almost 3/4 of patients, who had discussed about hospice, used it however within a year of diagnosis, which – as we know from other studies – is associated with improved quality of life for patients with advanced cancer.

In summary, I wholeheartedly welcome the idea of “advance care planning consultations”. I sincerely hope that such consultations will initiate what has been long due in the American health care system – a thoughtful care that results from careful discussions and planning between patients and their doctors, as opposed to a care that is chaotic, based on assumptions, and frequently in conflict with patients’ deep held values.