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Medical care guidance plan

When a person can't make a decision about their own care – for example, if they have dementia or have had a serious stroke – other people have to make those decisions for them. That's when health professionals use a medical care guidance plan.

A medical care guidance plan helps health professionals decide how best to treat that person, bearing in mind what the person would prefer if they could speak for themselves. It is especially important if different doctors are looking after them – for example, if they have to go into hospital.

This plan is different from an advance care plan.

A person creates an advance care plan, with the help of their GP or other health professional, while they are still able to decide what they want in the future. But a medical care guidance plan is created by a person's doctor (usually their GP) when they can't make decisions for themselves any more, and don't have an advance care plan.

The person may still be able to contribute to the plan, for example, if sometimes they are more aware and lucid. But family and friends have an important role, because they know the person and what might be important to them.

It may take some time and a lot of discussion to decide a plan for your friend or family member.

What does a medical care guidance plan include?

The plan includes important information such as what is happening with the person's health right now, what doctors think might happen in the future, and what might be the best way to care for them.

To help doctors make these decisions, the plan also includes information about the person and what they would want to happen.

It suggests how to achieve comfort and dignity at the end of the person's life, whether treatment should aim just to make them as comfortable as possible (palliative care) or try to restore them to the best health possible, and whether they want to be resuscitated if their heart stops beating and they stop breathing.

It's good to talk about the plan with the health professional who is helping your loved one.

What should we think about for the plan?

You can provide a lot of information to help your loved-one's doctor create the best medical care guidance plan for them. This includes:

Personal beliefs and preferences

Family wishes

Health and treatment

Will the plan exactly follow what we say this person would want?

The plan outlines what is in the person's best interests. It will follow their wishes if it is possible, clinically appropriate, and legal. However, some treatments might not be appropriate and might not be offered. The person's carers will talk to you about what is happening as their condition progresses.

Where is the plan kept, and when will it be used?

The plan is securely kept with your loved-one's health records, and will be transferred with them if they are moved to a new place (for example, if they have to go to hospital).

It will not be activated or used until it has been signed by your loved-one's doctor, after consulting the person who has their enduring power of attorney. So you should feel safe and comfortable discussing all options while the plan is being created.

Once it is activated, doctors will use it to guide them when they make decisions about your loved-one's care.

If you have any further questions about what a medical care guidance plan includes, how it can help your loved-one, and how you can contribute, talk to the health professionals caring for your loved one.

Written by Advance Care Plan implementation team, Canterbury DHB. Adapted by HealthInfo clinical advisers. Page created October 2016.

See also:

Advance care planning

Page reference: 257293

Review key: HIDLT-326665