MND – Advance Care Planning — SCE Neurology MCQ
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Correct answer: B — Advance care planning should include: preferred place of care and death, advance decision to refuse treatment (ADRT — e.g. refusing ventilation, CPR, PEG), lasting power of attorney for health and welfare, communication of preferences to family and clinical team, and emergency healthcare plan
Advance care planning is recommended early in MND (NICE NG42) while the patient retains capacity. It includes: (1) advance decision to refuse treatment (ADRT) — legally binding refusal of specific future treatments (e.g. invasive ventilation, CPR, artificial nutrition), (2) lasting power of attorney for health and welfare (appointing a trusted person to make decisions if capacity is lost), (3) preferred priorities for care (place of care, place of death), (4) emergency healthcare plan (ReSPECT/DNACPR decisions), (5) communication of wishes to all relevant parties. A: ACP is central to MND care. C: Patient's preferences are paramount. D: It must be done WHILE capacity is retained. E: Health and welfare LPA is separate from financial LPA.
Reference: NICE NG42 MND; Mental Capacity Act 2005