Advance care directive

We all know it’s possible that, at some stage, we might be faced with terminal illness or a life-threatening injury. However, it’s generally something we prefer not to think about too much. As a result, we may not have wondered how our medical care decisions would be made if we did become seriously unwell. How could we be looked after in the way we’d like if we were too ill to communicate what that was?

At an already hard and distressing time, medical decisions would be very difficult for our families and friends to make for us. But the task would be much easier if there was a way they could know for certain what we preferred, or didn’t want, in the way of treatment options.

There is a way—it’s called an Advance Care Directive.

What is an Advance Care Directive?

An Advance Care Directive (or ACD) is a written document in which you give directions, in advance, for what medical treatment(s) you would want to receive if you became unable to make or communicate those directions yourself.

The ACD is intended to be followed if you acquired a serious medical condition that required life-prolonging treatment and prevented you from giving medical instructions. These conditions could include things like:

severe and irreversible brain damage
a terminal illness with no known cure or chance of recovery
a severe illness or injury with little to no likelihood of recovery.

At such a time, your family and treating doctors can refer to the ACD as a record of your instructions about whether to continue or stop medical treatment.

What’s in an Advance Care Directive?

Normally, the ACD will contain instructions about whether to stop certain life-saving medical treatment if there was no reasonable expectation that you will recover. It can also include:

details of what is important to you, such as your values, life goals and preferred outcomes,
directions about medical conditions that you would find unbearable,
instructions about future medical treatment you consent to or refuse,
details of your appointed Enduring Guardian, medical decision maker or next of kin
any particular moral, religious or other reasons for your decisions.

The length and content of the ACD will depend on the template that you use. At the end of this article, you’ll find links to the different templates for the various Australian states and territories.

Why should you make an Advance Care Directive?

Thanks to medical science, people can now expect to live longer than previous generations did. However, this increased life expectancy doesn’t guarantee a correspondingly increased—or even maintained—quality of life. So some people might prefer not to receive life-prolonging medical treatment if they were faced with the prospect of spending their remaining time bedridden, in pain, affected by advanced dementia or suffering a terminal illness.

Sometimes these conditions can rob a person of the ability to make or communicate their own medical decisions. That’s why it’s so important to record your decisions and preferences in advance by making an ACD.

You don’t have to wait until you have a life-threatening illness or injury to make an ACD. If you have an opinion about, or have already decided, what medical treatment(s) you would not want to receive and when you would not want to receive it, you should document these wishes. And the appropriate way to do so is an ACD.

Your ACD will give certainty to your family and medical staff and take any guesswork out of choosing medical care for you because it will provide a clear record of your directions and wishes that they can refer to. This can alleviate feelings of responsibility or guilt your guardian or next of kin might have over having to make decisions about ending life support.

An ACD can also help to avoid potentially stressful and expensive court proceedings. Let’s look at what could happen if a patient has expressed their wishes about life-sustaining medical treatment but hasn’t recorded them in an ACD.

Their treating doctors may be reluctant, or refuse, to stop treatment in case they face criminal or medical practice disciplinary action for acting without the patient’s written directions.
A relevant person (for example, a close family member) can apply to the court to authorise the stopping of treatment. The court may agree, depending on the evidence before it, but there’s no guarantee it will, and the whole process can be time-consuming and costly.

This is why someone who has communicated any directions for the medical treatment they would like to receive if they faced a life-threatening illness or injury should formalise those directions in a valid ACD.

How do you make an Advance Care Directive?

The laws and regulations relating to ACDs differ between the states and territories. Even the terminology used is not the same Australia-wide. Each state and territory has its own guides, forms and information. Even though a valid ACD made in one state or territory will apply in other places within Australia, it’s best to make an ACD in your permanent home state.

Generally, your ACD must be dated and signed before an eligible witness. You should preferably complete and sign your ACD with a solicitor or doctor, or both. This will provide evidence, if needed, that you understood the nature and effect of the ACD when you signed it and received advice prior to signing.

The ACD usually requires supporting documentation such as a valid appointment of a guardian or a medical decision maker appointment. To find out the requirements in your state or territory you can access the Create Your Plan page on the Advance Care Planning Australia website.