The conversation about end-of-life planning - once socially taboo and largely avoided - has become so much more open in Australia in recent decades. We now know how important these sorts of discussions are in reducing the confusion and distress of not knowing a loved one’s wishes, and in providing them with the best possible care in the final stages of their life.
An Advance Care Directive (or Advance Health Care Directive) is an important part of end-of-life planning and refers to putting together a document explaining the type of medical care you want to receive if you’re considered incapable of understanding and making decisions for yourself.
There are different names for these documents depending on which state or territory you’re in and they’re also sometimes called Living Wishes, Advance Personal Plan or Health Direction.
Although they can complement each other, it's important to know that an Advance Care Directive is different to an Enduring Guardianship.
They both come into operation in the situation where you’re unable to make your own medical decisions, but Advance Care Directives are guides to your wishes about medical treatment, whereas an Enduring Guardianship is the legal appointment of a substitute decision maker who can make decisions with or without a set of express wishes.
Even with these general definitions, though, the nuances can be very different under the law and highlight the importance of consulting a legal adviser when setting up an Advance Care Directive.
Modern medicine is developing at a fast pace and the range of available treatments on offer grows by the day. Not everyone wants to be subject to invasive or costly treatments with an uncertain outcome or to have their lives extended indefinitely.
You need to consider having an Advance Care Directive if you feel strongly about the type of care you want to receive at the end of your life or if you’re injured or too ill to make your own decisions.
An Advance Care Directive can be made by any adult with legal decision-making capacity. You can create an Advance Care Directive at any stage of your life but they are particularly important as you get older, become frailer and more vulnerable to accidents and ill-health.
Doctors, medical professionals and family members are bound to follow your wishes if you’ve made a valid Advance Care Directive - they can’t override or disregard the document.
They also give your family the security and peace of mind knowing that they’re caring for you in the way you’d want them to.
There are publicly available procedures and forms in Australia that enable you to create a binding Advance Care Directive. However, not every Australian state or territory requires you to do so.
If a specific form isn’t available (like in NSW where the “common law” applies) you can make your wishes known by writing them down yourself.
Signing and having the document witnessed is recommended, and it’s required in states and territories that have statutory Advance Care Directives.
Where forms are available they can generally be found via links on the websites of state and territory trustees, departments of health and seniors associations.
Because the law regarding Advance Care Directives varies Australia-wide, you should get legal advice to help you understand how to put together an Advance Care Directive, and what the possible consequences and outcomes are likely to be.
If you’re unable to make medical decisions on your own behalf and you have no Advance Care Directive, your doctors or carers will usually ask close family members to make the relevant treatment decisions.
While this may be the best option in the circumstances, the decisions made may not be in line with your values and preferred outcomes. Family members might have their own agenda, or be influenced by medical carers and act in a way that you would disapprove of.
Advance Care Directive forms usually include your name and personal details as well as one or more of the following things:
While the thought of planning for unfortunate or unexpected events is unappealing to most of us, preparing an Advance Care Directive is a clear way of giving your family some certainty and guidance when they need it most.