Advance Care Planning is Wrong: Podcast with Sean Morrison

Sean Morrison dropped a bomb. It's a perspective I've heard before from outside of palliative care, most clearly by bioethicists Angie Fagerlin and Carl Schnieder in their landmark article Enough: The Failure of the Living Will. But Sean Morrison, Director of the National Palliative Care Research Center and Chair of the Department of Geriatrics and Palliative Medicine at Mt. Sinai, former President of the American Academy of Hospice and Palliative Medicine, is about as inside palliative care as one can get. Sean argues in his Journal of Palliative Medicine piece that we should stop putting resources into making advance care planning and advance directives work. For decades, we have tried and tried, pouring $300 million dollars into research, untold intellectual capitol, at the expense of those resources going toward other areas of need such as disparities in access and outcomes for people with serious illness. And what do we have to show for it? 1660 studies and 80 systematic reviews providing weak low quality evidence that advance care planning and advance directives impact outcomes. Sean likens this to his family's efforts to fix their fundamentally flawed Ford Pinto, an analogy we take to new heights in this week's podcast. We challenge Sean about his perspective in the podcast, as I'm sure many of you are eager to do. We love it when people write perspectives or do research that challenges accepted geriatrics or palliative care practice/dogma. This article should force us to think deeply and do some serious reflection about our clinical and research priorities, and the extent to which advance care planning and advance directives should be ranked highly among them. And, of course, great song choice: Won't be Fooled Again by the WHO. If you watch the Youtube video to the end, you get to see me do my best Pete Townshend impression. Enjoy! -Alex Smith @AlexSmithMD