Advance Care Planning (ACP) was introduced as a means of empowering individuals to make informed decisions regarding their health and end-of-life care. It is a way for individuals to contemplate their own personal values and to exercise autonomy. However, there is reason to believe that ACP may not be widely taken up and when adopted, may not be applied as intended. The ethical challenges facing ACP need careful study. This essay focuses on two problematic ethical aspects of ACP:
a strict adherence to procedural formalism,
an over-emphasis on individualistic autonomy, which can lead to hindrances in its implementation.
These may explain both the low uptake as well as its ineffectiveness. ACP should not be a compliance exercise and implementers will need to think hard about when and how to implement ACP, given cultural and perceptual sensitivities. By discussing the concept of “narrativism” and “relational autonomy”, we provide an avenue for solving the dilemmas faced and present a scenario that is closer to the ideal of what the ACP framework hopes to achieve. This would include patient preference as well as best interest and family values. An increased uptake of ACP will be a useful health service delivery indicator, but this would also entail developing a more morally mindful and just society in a broader sense.