This presentation gives participants the opportunity to review major conceptual insights into planning care for serious illness, starting from the demand for honesty about the options, working through the challenges of having so few cultural landmarks for long-term illness with ambiguous timelines, and addressing the changing challenges of caregiving. Categorizing trajectories of illness allows mass customization of service arrays and appears to be especially useful in making appropriate services readily available. But still, patient and family preferences must determine the actual course, so some practical pointers on how to frame and elicit those conversations will be in order. I close with some very challenging issues: assuring quality in the timeliness of death; defining quality of care plans across settings; and conceptualizing quality in unique situations. These issues are still unsettled, but the requirement to plan ahead in order to honour the informed choices of persons living with fatal illness is a settled mandate of good care.
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