In the UK, advance decisions to refuse treatment have been legalised under the Mental Capacity Act of 2005. They are one aspect of the wider process of advance care planning (ACP). A process of consultation during 2007 led to guidance for ACP being developed for health and social care professionals working in England (second edition published in 2008) by the National End of Life Care Programme which has been widely used for education and practice development. Debates about ACP in England subsequent to publication of this guidance has drawn attention to a number of areas of confusion and disagreement which could impede the development of practice in ACP. These include debates about whether ACP should be focused on preparation for future loss of capacity or whether its scope should be broader. These debates are mirrored in the research literature. This presentation reports work undertaken to revise and refine the guidance to address these areas and to promote a broad consensus across experts in the field and front line staff. The exercise to develop this guidance sheds new light on some of the challenges of addressing potentially divergent perspectives at a policy level and on issues to be considered when providing practical guidance in a complex field to underpin ACP practice and education on the front line.
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