Both the medical and social dimensions need to be incorporated into single courses of action due to the dual nature of advance care planning. Social marketing that focuses solely on the consumer may, in it purest form, inform the process. However, if the last 30 years has taught us nothing else, the clinical considerations tied to advances in medicine and proxy decisions require their integration into the advance care planning process. The complexity of this effort is underscored by this thoughtful reflection:
Here then is the most poignant dilemma faced by caregivers:
not wishing to condemn the worth of people’s lives,
yet not wanting to bind them to the rack of their growing misery;
not wishing to say they are better off dead,
yet not wanting always to oppose their going hither.
Under these circumstances,
with no simple formulas for finding the best course of action,
individuals and families must find their way,
case by case and moment to moment,
often with only unattractive options to choose from and knowing that whatever path they choose, they will feel the weight of the path not chosen.
Eric Cohen & Leon R. Kass
Cast Me Not Off in Old Age