Advance care planning under the Mental Capacity Act 2005 in primary care.

INTRODUCTION The past two decades have seen substantial change in the way medicine is practised in the UK, with a decisive shift away from paternalistic medicine. This has involved an increasing emphasis on the rights, views, and choices of patients, and on respect for their autonomy in decision making with regards to their health care. At the same time, however, has come the recognition that there are situations where patients are unable to make decisions for themselves; that is, where they lack capacity. Introduced in April 2007, the Mental Capacity Act 2005, in addition to defining the test for mental incapacity, is primarily intended to address this problem, establishing a framework for decision making on behalf of incapacitated patients, aiming to ensure that all decisions are made in such patients' best interests. In doing so, it places on statutory footing various elements of anticipatory decision making or advance care planning (ACP). Already practised for some time in the US, Canada and Australia, ACP is based on the belief that personal autonomy in decision making should be preserved wherever possible, and aims to give patients a way to continue to exercise their autonomy once they are unable to make decisions for themselves. ACP is now strongly promoted in UK healthcare policy,