Advance Care Planning is Wrong: Podcast with Sean Morrison

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GeriPal - A Geriatrics and Palliative Medicine Podcast 46 min 3 speakers 8 chapters transcribed 6 hours ago
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What is the main controversy behind Sean Morrison’s view on advance care planning?

Ann Kelley 0:01
The Jerry Powell Podcast is brought to you by Archstone Foundation, preparing society and meeting the needs of an aging population. And now, here are your hosts.
Eric Widera 0:12
Welcome to the Jerry Powell Podcast. This is Eric Widera.
Alex Smith 0:15
This is Alex Smith.
Eric Widera 0:17
And Alex, after a long summer break, we're getting back to the thick of things. We have two guests with us. Both of them are recurring.
Alex Smith 0:25
Both of them are recurring. And Kelly is back with us. She's a recurring co-host and social worker. Welcome back.
Eric Widera 0:32
Thanks. Nice to see you. And the Jerry Powell intro-er. So that's the voice that you hear at the beginning of every Jerry Powell podcast and Kelly's voice.
Alex Smith 0:41
That's Ann Kelley. And we have Sean Morrison, who is a repeat guest to this podcast, who is the chair of the Department of Geriatrics and Palliative Care at Mount Sinai, and also the director of the National Palliative Care Research Center. Did I get all that right, Sean?
Sean Morrison 0:58
You got all that right, Alex. It's good to see you guys again.
Alex Smith 1:01
Good to see you. Welcome
Eric Widera 1:03
back. And Sean, we're going to be talking about a recent JPM article, Journal and Palette of Medicine article titled Advanced Directive Slash Care Planning, Clear, Simple, and Wrong. A lot
Sean Morrison 1:14
of
Eric Widera 1:14
controversy there. Wrong! But before we do, we asked for a song request. Do you have a song request for Alex?
Sean Morrison 1:21
I do have a song request for Alex. Alex, I would love to hear the Who's Won't Get Fooled Again.
Alex Smith 1:26
I love this song. So I wasn't a fan of The Who growing up, but I had so much fun listening to this song on YouTube, listening to Pete Townsend play it in his 60s, and that's age 70 on YouTube. There's a recording of him playing acoustically. I shared it with my son, who's a budding guitarist. And wow, I have to say, I think Pete Townsend has the best right hand in all of rock history, maybe. So thank you for choosing this. I do not have the best right hand, but we'll see what happens.
We'll be fighting in the street with our children at our feet and the morals that they worship will be gone. And the men who turn us on Sit in judgment of our own They decide and the shotgun sings a song I tip my hat to the new constitution Take a bow for the new revolution Smile and grin at the change all around Pick up my guitar and play Just like yesterday,
Alex Smith 2:57
I'll get
on my knees and pray. We won't be fooled again.
Alex Smith 3:06
Well, there's my hack version. Oh, it's brilliant. It's
Sean Morrison 3:18
absolutely
Alex Smith 3:19
brilliant.
Sean Morrison 3:19
Do you like how I had to scroll
Alex Smith 3:21
the screen to see the next lyrics partway through?
Eric Widera 3:24
We usually ask the person doing the request, why did you pick the song? But we won't get fooled again is a pretty good indication of the topic at hand. And I'm going to just start off with a quote from your JPM article. The history of advanced directives, advanced care planning reminds me of my family's 1975 Ford Pinto. A car with a fundamentally flawed design, yet whose every broken part we dutifully repaired for five years until it was finally and mercifully sold for parts. Why do we keep waiting for advanced directives, advanced care planning to work? Wow. First of all, you had a Ford Pinto and
Sean Morrison 4:09
you
Eric Widera 4:10
didn't blow up
Sean Morrison 4:12
in
Eric Widera 4:12
it.
Sean Morrison 4:13
The gas tank didn't blow up. It just died eventually. But yes, we did have a Ford Pinto. Okay.
Eric Widera 4:21
So let's talk about advanced directives and advanced care planning. You know, I see a lot of lumpers and splitters. Are we going to combine both advanced directive and advanced care planning into like this stuff just doesn't work or are you focused one on one or the other?

How does the Ford Pinto analogy illustrate the flaws in advance directives?

Sean Morrison 4:36
I avoid the critiques that I get that they're not the same thing and one has evolved from the other and we're not going to talk about advanced directives. Why don't we talk about one and then the other? And I think this comes back to that analogy that you read, Eric, which when you read it sounds a lot more harsh than when I wrote it on the page.
Yeah.
Sean Morrison 4:59
But, you know, if we go back, and I've got enough gray hair that I can go back this far. But if we go back until the 70s, and we really started thinking about what was a major problem in healthcare, and one was that people were receiving treatments at the end of life, when they couldn't make decisions for themselves, that appeared not to be consistent with their wishes.

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