Just ask: discussing goals of care with patients in hospital with serious illness

Heyland and his coauthors describe the problem of patients who do not wish to establish advance care plans. They observe that "It is important to be sensitive to this [preference] and to recognize that such conversations are a process rather than a single event. If one senses a lack of readiness on the part of the patient, it may be useful to address barriers..."

As well as addressing barriers, physicians caring for patients at risk of dying have a strong ethical obligation to tell patients and their families about hospital policy, usually full code by default, even in the face of patient preferences not to engage in advance care planning.

'Of course you do not have to decide what you want at this time, but in the absence of your decision, hospital policy, including CPR and admission to an ICU would be undertaken if you were to become seriously ill or die suddenly. Do you know if you would or would not want these kinds of treatments?'

The absence of advance care planning does not result in the absence of advance care plans.

Conflict of Interest:

None declared