Advance Care Planning
There are two aspects to ensuring your personal wishes for medical treatments and interventions at the end of your life are respected.
Firstly, an Advance Care Plan is an ongoing process of shared planning for current and future health care that you create with your GP. Everyone should consider advance care planning, regardless of their age or health.
An Advance Care Directive (also known as a Living Will or ACD) is a legal form that outlines a person’s values, beliefs and choices for medical treatments and interventions and other care should they find themselves not able to communicate their decisions for themselves.
An Advance Care Directive comes under different laws in each state/territory in Australia, but essentially, the legal requirements are the same. The best place to access information about Advance Care Plans/Directives is at Advance Care Planning Australia’s comprehensive web site which provides detailed information for your state or territory.
In simple terms…. the plan is what you want to happen and the directive is the legal form you complete to ensure that it does happen.
ACDs come in different formats and sizes, from a 2-page sheet to a 10-page booklet that provides an explanation as you go. Once again, I recommend you access Advance Care Planning’s web site for more information.
Advance Care Directives are important tools used to help guide a nominated Enduring Guardian, ‘Person Responsible*’, next-of-kin or loved ones, palliative care support staff, doctors and other medical staff to respect a person’s end of life health choices.
A ‘person responsible’ is nominated in the Directive to advocate for a person on their behalf when they are not in a position to do it for themselves (because of a stroke, dementia or some other medical condition that hinders communication). In the early days Advance Care Directives were such a grey area that they were sometimes overlooked or overridden by a medical team (particularly in an Emergency Department), but nowadays as they become more ‘the norm’, if they are completed correctly and the attending team knows about and can access the form, the patient’s wishes will be respected.
5 important things to know about Advance Care Directives in Australia
- The person initiating an Advance Care Plan must be of sound decision-making capacity* when it was written and signed.
- The document must be clearly written (some would argue that it can be a verbal instruction but have it written, witnessed and signed to be sure) preferably on an Advance Care Directive form (in South Australia it must be written on the official form provided by the SA government).
- It must include specific details about treatments the subject would accept or refuse.
- It must be current and relate to the current medical problem.
- The subject was not influenced by anyone when the Directive was written; the nominated Person Responsible has signed it and it is witnessed by an independent person (not a person responsible for you healthcare).
3 points about proving capacity*
- You must prove to your witness at the time of signing that you understand and can foresee the effects of any decisions that you make;
- you must be able to show that you are voluntarily making the decisions about your health, and
- you must be able to communicate these decisions to the witness.
A healthcare professional may be more likely to honour the terms of an ACD if:
They have actively taken part in discussions of treatment preferences with the patient or can communicate with medical staff who have; they are aware of its existence well in advance of its use, and patients, guardians and designated decision-makers keep up ongoing communication with healthcare professionals about the contents of an ACD and the values and convictions behind it.
Where to get an Advance Care Directive
The best place to get an Advance Care Directive is with your regular GP, as you will want to go through it with them so they can explain the consequences of your choices and also so they can understand the reasoning for the choices you have made. They will be more willing to support you in your choices if they understand why you have made them.
If your regular doctor does not have an Advance Care Directive form to give you, ask them to find one for you, because we need to help educate those doctors who don’t see this type of planning as an essential part of their service.
Check out the Advance Care Directive relevant to your state/territory and download it from this web site. Their Advance Care Planning Advisory Service is open 9am-5pm Monday to Friday on 1300 208582.
Our Living Better; Dying Well newsletter provides information and links through to free forms available for the state or territory in which you live. Sign up here to receive the newsletter free or buy The Rest Easy Kit, which includes this information as a bonus. You can also access our Glossary of Terms here if you are not sure of any of the terms mentioned in this article.