Important milestones and decisions in our life require careful thought and planning. Advance care planning and advance care directives are one of the many ways we can plan ahead for the future. Whether you’re thinking about your own advance care directive or helping your loved one through the process, starting the conversation about advance care directives can make a meaningful difference in the long term. Read on to learn more about advance care directives and how you can start advance care planning.
What is an advance care directive?
Also known as a ‘living will’, an advance care directive is a legally binding document that outlines an individual’s preferences for how they want to be cared for in the future.
An advance care directive is a formal version of an advance care plan which outlines an individual’s decision about their end-of-life care. Health professionals and family members are required to follow the preferences outlined in a valid advance care directive.
Individuals may hold different views about the type of care they want to receive towards the end of their life. These views may vary depending on their religious beliefs and goals. Outline these preferences in an advance care directive ensures an individual’s preferences can be respected and upheld.
In an advance care directive, individuals can also appoint a substitute decision-maker in the event that they are no longer able to make decisions for themselves.
Did you know? Advance care planning legislation differs across states. Check your state’s legislation on how to create an advance care directive before you start!
Why is an advance care directive important?
Thinking about your advance care directive early on is incredibly important in ensuring your well-being in the future. Planning the type of end of life care you might prefer, considering the available options for your unique needs and documenting your preferences in an advance care directive can help guide those around you and also ensure your needs are respected.
Advance care directives are an important healthcare tool with far-reaching benefits. With an advance care directive in place, healthcare professionals and loved ones can make an informed decision about your health and personal preferences.
Individuals and loved ones can have some peace of mind, knowing a plan is in place for the future. Although it is impossible to plan for every situation in life or control what will happen in the future, an advance care directive can provide some reassurance, as loved ones will know what treatment or care plan you prefer in the event of a crisis.
If you have designed a substitute decision make in your advance care directive, this can also help eliminate any uncertainty about roles and responsibilities.
Some additional benefits of an advance care directive includes:
- Reduced anxiety, stress and uncertainty about the future
- Confidence knowing you will be cared for in the way you want
- Opportunity to refuse the types of care you would not want
- Chance to nominate someone you trust as your substitute decision-maker
- Gives clear direction to healthcare professionals
- Preserves and maintains a sense of dignity as you will not receive unwanted treatment.
In the case where an individual becomes seriously ill and does not have a documented advance care directive or has not specified a substitute decision-maker, medical professionals will make decisions on an individual’s behalf based on their assessment of your best interests.
Who needs an advance care directive and when should you start thinking about an advance care directive?
Individuals facing a life-limiting illness, advanced chronic illness or at risk of dementia, may choose to start talking to loved ones about the type of care they wish to receive during the early stages of an illness.
But, anyone over 18 years can begin the process of creating an advance care directive for their future.
Advance care directives are formalised plans about your future health care, and everyone should consider advance care planning, regardless of age or health conditions. Ideally, having conversations about an advanced care plan before a major health crisis, allows individuals to plan while they are able to make informed decisions and communicate without pressure or pain.
Planning early on also allows individuals plenty of time to think about their preferences, consult health professionals and record their decisions.
Conversations about your health care preferences don’t have to stop and can also continue throughout your life and well after you’ve created your advanced care directive.
Don’t forget: While it can feel daunting to talk about difficult topics like illness, health outcomes for people and their families can improve when they talk through their concerns, and preferences with health professionals. Start the conversation today.
Is an Advance Care Directive different from a Will?
Advance care directives are also referred to as a ‘living will’, but it functions differently to a Will.
When individuals write a Will, they outline how their assets will be distributed after death. A Will is a legally binding document that only comes into effect after the author of the Will is deceased. Advance care directives however, may come into effect while an individual is still alive.
Fact: An advance care directive is also different to voluntary assisted dying (VAD). The process of writing an advance care directive involves discussing future health care options and making decisions about the types of treatment an individual would refuse or prefer.
How to make an advance care directive
If you’re ready to make an advance care directive, here are some things to consider before, during and after:
Before you write an advance care directive:
- Advance care directives are considered valid when an individual is aged over 18 and has the mental capacity to make decisions about day-to-day matters about their health care, finances and personal life.
- Consult your doctor and health professionals for advice on your current health, future choices and options.
- Start conversations with your family members and take a moment to communicate your preferences with them.
- Think about your personal goals, past health experiences and values.
It can be difficult to know what you prefer. Here are some questions to consider that may help you determine your health care preferences. You may want to discuss these questions with a loved one or health professional:
- What are your past medical or healthcare experiences?
- Have these positive or negative experiences of healthcare in the past shaped your preferences?
- What would you do in a situation where you can no longer take care of yourself?
- What is your current health like and how does it impact you?
- What matters most to you and what determines a good quality of life?
- What daily activities help you feel independent?
- Do you hold any religious or spiritual beliefs that impact your choice of medical treatment?
- Who is someone you would trust to make decisions on your behalf?
- If someone you cared about was in your situation, how would you support them?
Writing an advance care directive:
- An advance care directive should include details of what is important to you and your preferred way of living, the life-prolonging treatments you would accept or refuse in the event of a health crisis, your nominated substitute decision maker. Some examples of life-prolonging treatments can include:
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- Cardiopulmonary resuscitation (CPR)
- Artificial ventilation (breathing machines)
- Tube feeding
- Dialysis (kidney machine)
- Palliative care
- Chemotherapy or radiotherapy.
- A lawyer is not required to write your advance care directive.
- Each state has different processes and documentation required when submitting an advance care directive in each state. Learn more about how you can complete an advance care directive form, relevant to each state or territory here.
- Record your substitute decision-maker in the required process, as required by your respective states or territory.
- Where possible, include your name and contact details, as well as the contact details of substitute decision-makers.
- Finally, we recommend uploading your documents to My Health Record.
After you’ve written your advance care directive:
- Speak to your loved ones and take a moment to explain the decisions you’ve made in your plan.
- Provide copies of your advance care directive to your family, substitute decision-maker, hospital and doctor.
Learn more about how you can write an advance care directive in your state here.
How to choose a substitute decision-maker
An advance care directive requires you to select a substitute decision-maker. This title can change depending on your state or territory:
- ‘Medical treatment decision-maker’ or ‘medical enduring power of attorney’ in Victoria
- ‘Enduring guardian’ or ‘person responsible’ in in New South Wales, Tasmania and Western Australia
- ‘Enduring power of attorney’ in Queensland and ACT
- ‘Substitute decision-maker’ in South Australia
- ‘Decision-maker’ in the Northern Territory.
A substitute decision-maker is someone you nominate to make decisions about your medical treatments and care when you are not in a position to make these decisions for yourself.
The person you select as your substitute decision-maker should be someone who values your well-being, can listen to your preferences and will be able to make a confident decision about your preferences.
Depending on the state or territory you live in, the requirements of a substitute decision-maker can be different. You may choose to select a partner, family member, close friend, religious leader or legal representative.
The roles of a substitute decision-maker includes:
- Make decisions about life-long treatments and health care on behalf of someone who can no longer make decisions for themselves
- Supports someone with no decision-making capacity
- Advocate for a person’s health care preferences when they are unable to communicate
- Understand and respect someone’s health care decisions.
Individuals may select an alternate substitute decision-maker. The role of an alternative substitute decision-maker is to make decisions when the primary decision-maker nominated in the advance care directive is unable to.
Questions to ask when selecting a substitute decision-maker:
- Do I know this person well, and do they know me well?
- Are their character and reputation trustworthy?
- In what past life experiences has this person shown to be dependable?
- Will this person have the right support to make the best decision for me, as outlined in my advance care directive?
- Can this person confidently make a decision in high-pressure situations?
Updating or revoking an advance care directive:
Once you or a loved one has written an advance care directive, this document can be updated.
Advance care directives should be updated if your preferences change if you wish to update your substitute decision-maker or if there are changes to your general health.
In some cases, an advance care directive may be cancelled or revoked by speaking with your health professionals and contacting the National Advance Care Planning Support Service.
New copies of your updated advance care directive should also be reuploaded to My Health and shared with your substitute decision-maker and relevant loved ones.
Helping a loved one write an advance care directive:
Talking about advanced care directives can be tough and confronting for you and your family members. The topic of illness and possibly death is never easy to approach, but having a plan in place is incredibly important for you and your loved ones.
In the event of serious illness or injury, individuals may no longer be able to make important decisions about the health care and treatment that they prefer.
You can help prompt a loved one, particularly if they are elderly or facing terminal illness or chronic illness, to consider what they might include in an advanced care directive. You can encourage your loved ones to consult a medical professional and evaluate their life-long values and their preferences.
Remember: It’s important to practice empathy and respect that people may have different values and goals about their health care needs. Listen to a loved one’s reasoning before you express your opinions about their health preferences.
Resources where you can get help:
If you require support in writing an advance care directive or need help updating your advance care directly, visit Advance Care Planning Australia for templates and information.
You can also contact the National Advance Care Planning Support Service by calling 1300 208 582 from 9am–5pm (AEST/AEDT).
