Advance Care Planning allows a person who has mental capacity to plan ahead for what medical or dental treatment and other personal care they might or might not want in the future if they have lost capacity.  This can happen unexpectedly due to an accident, illness or disability.

There are two components to Advance Care Planning:

•             the first is to appoint a substitute decision-maker of your choice;

•             the second is to complete a statement of your values and wishes.

Substitute Decision-Maker

All States/Territories in Australia have specific legislation which allows a person with capacity to appoint someone to make personal and health care decisions for them if they are unable to make those decisions for themselves.  The person appointed is referred to by various names throughout Australia, including Enduring Guardian, Enduring Power of Attorney (personal and health care), Enduring Power of Attorney (medical treatment) and medical agent.  Here we will use the term Enduring Guardian but see below for links to documents and terminology for your State/Territory.

Enduring Guardian: An Enduring Guardian is someone you appoint to make lifestyle and health care decisions should you lose the capacity to make your own decisions at some time in the future.  You can appoint one person or more than one; different rules apply in each State/Territory if more than one person is appointed (see the link at the end of this section for more information).

The person you appoint should be someone you trust, who will make the decisions that you would make if you were competent to speak for yourself (even if it is not the decision s/he would make).  In order for the person to do that, you will need to discuss your values and wishes with that person, e.g., what do you consider an acceptable quality of life? or when would you want invasive treatments to stop and for you just to be kept comfortable and allow you to die naturally?

It is also advisable that you appoint someone who will be strong enough to stand up for your wishes, e.g., against other family members who might be insisting that you receive invasive treatment that you said you did not want, or against doctors or other health care providers who are proposing on-going tests or procedures that will provide no real benefit to you, or that you have said you would not want.

Statement of Values and Wishes:

In addition to having the conversation with the person/people you appoint as your Enduring Guardian(s), you can also make their job easier – and provide more certainty for yourself – if you write a statement of your values and wishes.

All States/Territories in Australia allow a person with capacity to write a legally-binding statement of their values and wishes for their future care and treatment if the time ever comes when they cannot speak for themselves.  In all States/Territories except New South Wales and Tasmania, there is specific statute legislation (i.e., laws made by Parliament) governing such statements; in NSW and Tasmania they are legally binding under the Common Law (i.e., law that has developed from cases in the Courts).  Such statements are referred to by various names throughout Australia, including Advance Care Directive, Advance Health Directive, Advance Personal Plan, Health Directive or Statement of Choices.  Here we will use the term Advance Care Directive but see below for links to documents and terminology for your State/Territory.

Advance Health Directive

Every competent adult has the legal right to accept or refuse any recommended health care.  This is relatively easy when we are well and can speak for ourselves. Unfortunately, during severe illness people are often unconscious or otherwise unable to communicate their wishes – at the very time when many critical decisions need to be made. By completing an Advance Care Directive (ACD), you can make your wishes known before this happens. It comes into effect only if you are unable to make your own decisions.

An ACD is a document which allows a competent adult (person 18 years of age or older) to express their decisions about their future medical treatment and health care, including their wishes and values (religious and/or cultural), in case at some time in the future they lose the capacity to make such decisions for themselves.   Although not legally required in every State/Territory, it is advisable to ask your doctor to sign the document to verify that you had capacity when you made it, and then you should sign it in front of an independent witness. (Witnessing requirements also vary throughout Australia – see link below).

It is advisable to discuss your ACD with your family, your health care providers and your friends if you wish, so that everyone is aware of your wishes and your reasons for making those decisions, although you can choose not to do this if you prefer.  It is also important to make several copies of the ACD document to distribute to everyone who may be involved in making healthcare decisions for you if you lose the capacity to do so yourself, such as:

o   Your Enduring Guardian (if you have appointed one);

o   Your medical practitioner (to place in your patient file)

o   Other family members

o   Hospital or residential aged car facility admissions staff, where relevant.

If another family member or friend is concerned that the person you appointed as Enduring Guardian is not acting in your best interest, or that your wishes in your Advance Care Directive are not being followed, they should contact the Trustee and Guardian office in your State/Territory.

Feros Care strongly recommends that all care-recipients appoint an Enduring Guardian and complete an Advance Care Directive (or equivalent for your State/Territory). 

Information and documents relating to Advance Care Planning in all States/Territories in Australia can be accessed/downloaded free of charge from the web site of Advance Care Planning Australia.

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For free advice on all aspects of care planning call our aged care advice hotline on 1300 090 256 or fill in the form below.