ABSTRACT

Advance care planning (ACP) for medical decision-making at the end of life has developed around the expectation of death from long-term, progressive chronic illnesses. We reexamine advance care planning in light of the increased probability of death from COVID-19, an exemplar of death that occurs relatively quickly after disease onset. We draw several conclusions about ACP in the context of infectious diseases: interpersonal and sociostructural barriers to ACP are high; ACP is not well-oriented toward decision-making for treatment of an acute illness; and the U.S. health care system is not well positioned to fulfill patients’ end of life preferences in a pandemic. Passing the peak of the crisis will reduce, but not eliminate, these problems.

摘要

用于临终医疗决策的预先护理计划 (ACP) 是围绕长期渐进性慢性疾病导致的死亡预期而制定的。鉴于 COVID-19 死亡的可能性增加，我们重新审查了预先护理计划，COVID-19 是一种在疾病发作后相对较快地发生死亡的例子。我们对传染病背景下的 ACP 得出几个结论：ACP 的人际和社会结构障碍很高；ACP 对急性疾病治疗的决策没有很好的导向；并且美国的医疗保健系统无法很好地满足患者在大流行中的临终偏好。渡过危机高峰会减少，但不会消除这些问题。