Advance care plans: Why everyone should have one

In some states, an appointed enduring power of attorney may be able to make medical decisions on your behalf if you lose decision-making capacity. In other states it may be an enduring guardian.

Find all the forms and requirements depending on where you live at Advance Care Planning Australia.

Regardless of where you live, common requirements include questions about your current health and statements that help your chosen substitute decisionmakers make medical decisions on your behalf. These statements may include what quality of life means to you.

In general, a valid advance care directive will apply in other places in Australia, although there may be some limitations and additional requirements.

Similarly, the appointment of enduring guardian will usually apply interstate, but there is variation in the laws within Australia.

Specific advice is available from the Office of the Public Advocate or equivalent in the relevant state or territory.

If you are permanently relocating to a new state or territory, it is recommended you update your documentation using the recommended form(s) in consultation with your doctor and substitute decision-maker.

What makes an advance care directive valid?

An advance care directive is a legal document that can give a sense of certainty and control as your health declines.

However, for an advance care directive to be legally binding, the person completing it must be competent and it must be signed by a GP or health professional and a witness.

There are different forms to be completed by those acting on behalf of someone who may have lost the capacity to express their wishes, but they won’t be legally binding.

The involvement of a GP is to help remove any ambiguity around what a person may want and what they understand about medical interventions such as CPR or life-prolonging treatments.

For example, you may elect to have CPR provided the doctors expect a reasonable outcome. But a reasonable outcome can mean different things to people. For some, just being able to talk will be enough to want to keep living. For others it will be important to be able to talk and walk and anything less would be unacceptable.

Conversations are important

Starting the conversation about what sort of medical intervention you would want can come in many forms.

There is the shock approach. For example, if you were in a coma following a car accident, would you be okay being kept alive by machines? Or, if you have a terminal illness and medical treatment could delay your death by two months, would you want it?

Being clear about your wishes involves thinking carefully and sharing your beliefs, values and preferences regarding your current and future healthcare.

It is also about your attitude and life goals regarding healthcare treatment options and how well you understand what counts as life-prolonging treatments.

An instructional directive such as “I don’t want CPR” or “I don’t want to be tube-fed” is one way of looking at advance care planning.

Another way is to think about what is important to you or what it means to live well.

Before you start thinking “It will never happen to me” and “I don’t need one of those”, consider these statistics: 50% of people will not be well enough to make their own end-of-life medical decisions and one-third of us will die before the age of 75, most likely after a chronic illness rather than a sudden death.

Where should I put a copy of my advance care directive?

What you do with your completed directive is up to you. You can carry it with you, give a copy to your GP and local hospital, and/or upload it to the central health database My Health Care Record through myGov.

If you have appointed a decision-maker, they should know that you have an advance care directive in place and where to find it.

Your advance care directive is not set in stone and your views and decision about who you want to make decisions on your behalf may change. This makes it important to keep it up to date.

What difference will it make?

Generally, according to End of Life Directions for Aged Care (ELDAC), a health professional must follow a valid directive, even if it instructs them to refuse life-sustaining treatment that will result in a person’s death.

If they don’t follow the instructions, a health professional could be liable under criminal or civil law.

There are some limited circumstances in which a directive does not have to be followed, such as when it is not clear enough to guide decision-making or where circumstances have changed so much since completing the directive that it should not be followed.

Research has shown that advance care planning can reduce anxiety, depression and stress in families.

Family members who know a directive is being followed are also more likely to be satisfied with their loved one’s care.

Time for action

Fewer than 15% of Australians have documented their end of life wishes in an advance care directive.

While most of us have a clear view of what is important to us to live well and what we value in life, it’s important to take the next step and share that – preferably in writing. Even better, outline your wishes in a legal document relevant to your state or territory.

Without a clear statement of a person’s wishes, doctors must treat them in the most appropriate way to save their life. This can mean aggressive treatments that you or your loved one may not have wanted.

We have all heard stories of people being kept alive by machines or under circumstances that are undignified, possibly causing unnecessary suffering. As most deaths occur after a chronic illness rather than a sudden event, there is generally ample opportunity for an advance care directive conversation.