Allowing individuals to retain control over their health care even after losing mental capacity, advance care planning (ACP) can be seen as the ultimate expression of patient choice and empowerment. Evidence of the extent to which medicine has turned its back on paternalism, ACP has proved an attractive concept for healthcare policy makers, and recent years have seen increasing development of related professional guidance. Recognition in UK legislation in the Mental Capacity Act 2005 has further strengthened interest. Promotional initiatives for ACP, particularly in primary care, have focused on increasing its use, with one guideline advocating integration into the Quality and Outcomes Framework as a means of establishing ACP as a 'routine' part of care. The suggestion that something as complex and sensitive as ACP could be dealt with in a similarly routine and structured way to blood pressure monitoring or cardiovascular risk assessment seems surprising; certainly the possibility should lead to detailed examination of the implications of incentivisation of this process, as well as perhaps to a degree of re-examination of the concept itself.
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