Editorial

BMJ Support Palliat Care: first published as 10.1136/bmjspcare-2020-002612 on 21 August 2020. Downloaded from http://spcare.bmj.com/ on August 22, 2020 at Association for Palliative
Are advance care plans of author’s priorities, help them to
understand and balance treatment
options, and gain consent. An ACP
any value? then projects this process into a
future when the author cannot speak
for herself. This is not a measurable
Derek Willis  ‍ ‍,1 Rob George2 commodity but is a basic building
block of what it means and what
it is, to respect patients as people.
Recent papers in BMJ Support and So, what is the use of an ACP? This is the intrinsic use of an ACP
Palliative Care concerning advance Philosophers distinguish instru- and its justification, not that it
care plans (ACP) offer empirical mental from intrinsic value. Instru- reduces unnecessary admissions.
evidence that helps us to under- mental value emphasises outcome: We are then free to measure how
stand how ACP are, and should be, something is valuable because of we achieve this rather than just why.
applied.1 2 They are welcome and what it produces. Intrinsic value
timely as critics often argue that emphasises what value something Funding  The authors have not declared a
palliative medicine sometimes has, in and of itself. Like the person specific grant for this research from any
funding agency in the public, commercial
values opinion over evidence. whom an ACP concerns, it has or not-­for-­profit sectors.
However, even in medicine, some intrinsic value as a representation of Competing interests  None declared.
things do not need evidence as who they are—before it is an instru-
Patient consent for publication  Not
proof: indeed, their value may be ment to summarise what they want. required.
clear despite the evidence. ACP is an That misses the point dangerously.
Provenance and peer review  Not
example, properly done, it captures Hence, what matters is to accumu- commissioned; internally peer reviewed.
a unique narrative. Rationality late evidence to define how we do
and professionalism are the justi- ACP well rather than why we do it.4

Medicine. Protected by copyright.

© Author(s) (or their employer(s)) 2020.
fication: personhood, respect for That stands on its own moral foun- No commercial re-­use. See rights and
autonomy, confidentiality, consent dation of respect for autonomy and permissions. Published by BMJ.
are all inherent to healthcare. its derivatives.
The importance of ACP as a Either we record how many ACPs
person’s narrative (and not just are completed without really under- To cite Willis D, George R. BMJ Supportive
a quick reference for decision-­ standing why, or create an atmo- & Palliative Care Epub ahead of print: [please
making) is to protect them from sphere where we discuss proposed include Day Month Year]. doi:10.1136/
bmjspcare-2020-002612
being ‘done to’—the Liverpool interventions—like a hospital
Received 29 July 2020
Care Pathway in the wrong hands. admission—in the light of a patient Accepted 31 July 2020
Covid catapulted ACP into the as a person. People are not just at a
public mind as an admission-­ medical risk of bad deaths; they are ORCID iD
Derek Willis http://​orcid.​org/​0000-​0003-​
avoidance document and a covert also at social risk of being treated
2286-​2827
means of discrimination. As those as less than they are. Someone who
regularly using ACP to encapsulate has a life limiting illness deserves REFERENCES
a person’s priorities, values and hospital admission for procedures 1 Hopkins SA, Bentley A, Phillips V, et al.
future wishes we know this to be that could mitigate symptoms or Advance care plans and hospitalized
misuse at best and abuse at worst. modify disease fruitfully. Pinning a frail older adults: a systematic
We cannot risk such a valuable tool metastatic fracture, defunctioning review. BMJ Support Palliat Care
2020;10:164–74.
falling into disrepute. We have been an obstructed colon or irradiating 2 Neergaard MA, Skorstengaard MH,
here before.3 We are culpable if we spinal cord compression are cases Brogaard T, et al. Advance care planning
do not promote the true value and in point, but these decisions have and longer survival in the terminally ill:
purpose of planning ahead with to be examined in the light of that a randomised controlled trial unexpected
a patient in the light of who they person’s intrinsic story. An ACP’s finding. BMJ Support Palliat Care
2020;10:221–2.
are, promote what they want and instrumental value is only safe and 3 George R, Martin J, Robinson V. The
prevent what they do not. useful when it builds on the author’s Liverpool care pathway for the dying
intrinsic value. (LCP): lost in translation and a tale of
If one highlights mostly their elephants, men, myopia - and a horse.
1
Medical, University of Chester, Chester, UK Palliat Med 2014;28:3–7.
2
Medicine, King’s College London, London, UK intrinsic value, as Barclay’s paper
4 Willis.D KR, Jones.J. ‘What is the
infers,1 ACP cease to be controver- Evidence for Evidence ?’ International
Correspondence to Derek Willis, Medical,
University of Chester, Chester CH1 4BJ, UK; sial and risk abuse. The clinician Journalof Palliative Care 2015
​derekw@​severnhospice.​org.​uk is there to support and discuss the ;21:213–5. May.

Willis D, George R. BMJ Supportive & Palliative Care 2020;0:1. doi:10.1136/bmjspcare-2020-002612 1