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What is an Advance Care Directive?
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. In most countries, by completing an Advance Care Directive or similarly named document, you can make your wishes known before this happens. |
An Advance Care Directive is a document made by you in conjunction with your doctor, stating your wishes or directions regarding your future health care for various medical conditions. It comes into effect only if you are unable to make your own decisions.
The purpose of an Advance Care Directive is to give you confidence that your wishes regarding health care will be carried out if you cannot speak for yourself.
You may wish your directive to apply at any time when you are unable to decide for yourself, or you may want it to apply only if you are terminally ill.
Who can make an Advance Care Directive?
Anyone who is over eighteen years of age and is capable of understanding the nature of their directions and foreseeing the effects of those directions can generally make an Advance Care Directive.
What do I need to consider before making an Advance Care Directive?
You should think clearly about what you would want your medical treatment to achieve if you become ill. For example:
It is strongly recommended that you discuss this form with your doctor to ensure that you are very clear about the options available to you and the potential consequences of such directives. You may also wish to discuss your decisions with family members or close friends.
Before completing the form you will need to ask your doctor to complete the relevant section of the form.
Appointing an Enduring Guardian
As it would not be possible to anticipate everything in an Advance Care Directive, it is in your best interests to appoint someone to have Enduring Guardianship for you. This person can then make decisions on your behalf about your health-care and other personal matters not covered in this Directive if you are no longer able to do so.
If you have already given someone Enduring Guardianship, all you need to do is discuss this directive with that person and complete relevant section of the Advance Care Directive template form when you come to it.
It is important to discuss with your Enduring Guardian your views and wishes regarding your health care as you have set them down in your Advance Care Directives so that any decisions that they make on your behalf accord with your wishes.
I Have not Appointed an Enduring Guardian
If you have not yet appointed an Enduring Guardian and you wish to do so, you will need to complete an Appointment of Enduring Guardian form and have a lawyer or a registrar of the local court witness you and your Enduring Guardian, signing the form.
If you do not appoint an Enduring Guardian, the law varies but generally it provides for your decisions to be made by a 'person responsible', that is, the first, in order, of the following people:
However, that may not be the person you would have chosen.
Changing an Advance Care Directive?
Your wishes as stated in an Advance Care Directive are not final; you can change them at any time while you remain mentally capable of doing so.
If you do want to make major changes to your directive, you should destroy the current one and make a new one. If you make minor changes, make sure you sign and date alongside the change.
You may also totally revoke your directive at any time. This should be done in writing, so that you can give a copy to anyone who has a copy of your current Advance Care Directive, but no specific form is required and the person witnessing your signature does not need to be a justice of the peace or a lawyer.
It is wise to review your directive every two years or if your health changes significantly.
Once you have completed your documents it is important to store them in a secure place such as in a safe or with your solicitor and to advise the people you have appointed in your documents and key family members where your documents are stored.
It is particularly important that you give copies of your Enduring Guardianship form and your Advance Care Directives to people such as your GP, medical specialists and family members who may have to make decisions on your behalf in the future.
If you are admitted to hospital or to a residential aged care facility, make sure the hospital or staff know that you have an Advance Care Directive and either give them a copy of it or tell them where a copy can be obtained. You may also wish to carry a card in your purse or wallet stating that you have made a Directive, and where it can be found.
Further information
References and Sample Templates
There is no one single template and many different organisations have developed their own templates. General information can be found at:
http://www1.health.nsw.gov.au/pds/ActivePDSDocuments/GL2005_056.pdf
http://planningaheadtools.com.au/advance-care-planning/
http://healthlaw.planningaheadtools.com.au/advance-care-plans-and-the-law/#advance-care-planning-tools
You can download a copy of an Advanced Care Directives template at:
NSW:
http://www.engadinemedicalcentre.com.au/contents/en-us/Advance%20Care%20Directive%20Prof%20Colleen%20Cartwright.pdf
Queensland:
https://www.qld.gov.au/law/legal-mediation-and-justice-of-the-peace/power-of-attorney-and-making-decisions-for-others/advance-health-directive
UK Reference:
In the UK, an Advance Decision (sometimes known as an Advance Decision to Refuse Treatment, an ADRT, or a living will) is a decision you can make now to refuse a specific type of treatment at some time in the future.
Anne McR. Australia
NOTE: unless otherwise stated, the information in this document is based on the laws of New South Wales. People living in other places are invited to make their own inquiries. This document is for general information purposes only and does not constitute legal advice.
The purpose of an Advance Care Directive is to give you confidence that your wishes regarding health care will be carried out if you cannot speak for yourself.
You may wish your directive to apply at any time when you are unable to decide for yourself, or you may want it to apply only if you are terminally ill.
Who can make an Advance Care Directive?
Anyone who is over eighteen years of age and is capable of understanding the nature of their directions and foreseeing the effects of those directions can generally make an Advance Care Directive.
What do I need to consider before making an Advance Care Directive?
You should think clearly about what you would want your medical treatment to achieve if you become ill. For example:
- If treatment could prolong your life, what level of quality of life would be acceptable to you?
- Are there any special conditions that your health-care providers should know about?
- How important is it to you to be able to communicate with family and friends?
- If you were in a Residential Aged Care Facility and required palliative care would you prefer to stay in the Residential Aged Care Facility or go to hospital?
It is strongly recommended that you discuss this form with your doctor to ensure that you are very clear about the options available to you and the potential consequences of such directives. You may also wish to discuss your decisions with family members or close friends.
Before completing the form you will need to ask your doctor to complete the relevant section of the form.
Appointing an Enduring Guardian
As it would not be possible to anticipate everything in an Advance Care Directive, it is in your best interests to appoint someone to have Enduring Guardianship for you. This person can then make decisions on your behalf about your health-care and other personal matters not covered in this Directive if you are no longer able to do so.
If you have already given someone Enduring Guardianship, all you need to do is discuss this directive with that person and complete relevant section of the Advance Care Directive template form when you come to it.
It is important to discuss with your Enduring Guardian your views and wishes regarding your health care as you have set them down in your Advance Care Directives so that any decisions that they make on your behalf accord with your wishes.
I Have not Appointed an Enduring Guardian
If you have not yet appointed an Enduring Guardian and you wish to do so, you will need to complete an Appointment of Enduring Guardian form and have a lawyer or a registrar of the local court witness you and your Enduring Guardian, signing the form.
If you do not appoint an Enduring Guardian, the law varies but generally it provides for your decisions to be made by a 'person responsible', that is, the first, in order, of the following people:
- your spouse (if you have one);
- your carer (if you have one);
- a close relative or friend.
However, that may not be the person you would have chosen.
Changing an Advance Care Directive?
Your wishes as stated in an Advance Care Directive are not final; you can change them at any time while you remain mentally capable of doing so.
If you do want to make major changes to your directive, you should destroy the current one and make a new one. If you make minor changes, make sure you sign and date alongside the change.
You may also totally revoke your directive at any time. This should be done in writing, so that you can give a copy to anyone who has a copy of your current Advance Care Directive, but no specific form is required and the person witnessing your signature does not need to be a justice of the peace or a lawyer.
It is wise to review your directive every two years or if your health changes significantly.
Once you have completed your documents it is important to store them in a secure place such as in a safe or with your solicitor and to advise the people you have appointed in your documents and key family members where your documents are stored.
It is particularly important that you give copies of your Enduring Guardianship form and your Advance Care Directives to people such as your GP, medical specialists and family members who may have to make decisions on your behalf in the future.
If you are admitted to hospital or to a residential aged care facility, make sure the hospital or staff know that you have an Advance Care Directive and either give them a copy of it or tell them where a copy can be obtained. You may also wish to carry a card in your purse or wallet stating that you have made a Directive, and where it can be found.
Further information
References and Sample Templates
There is no one single template and many different organisations have developed their own templates. General information can be found at:
http://www1.health.nsw.gov.au/pds/ActivePDSDocuments/GL2005_056.pdf
http://planningaheadtools.com.au/advance-care-planning/
http://healthlaw.planningaheadtools.com.au/advance-care-plans-and-the-law/#advance-care-planning-tools
You can download a copy of an Advanced Care Directives template at:
NSW:
http://www.engadinemedicalcentre.com.au/contents/en-us/Advance%20Care%20Directive%20Prof%20Colleen%20Cartwright.pdf
Queensland:
https://www.qld.gov.au/law/legal-mediation-and-justice-of-the-peace/power-of-attorney-and-making-decisions-for-others/advance-health-directive
UK Reference:
In the UK, an Advance Decision (sometimes known as an Advance Decision to Refuse Treatment, an ADRT, or a living will) is a decision you can make now to refuse a specific type of treatment at some time in the future.
Anne McR. Australia
NOTE: unless otherwise stated, the information in this document is based on the laws of New South Wales. People living in other places are invited to make their own inquiries. This document is for general information purposes only and does not constitute legal advice.