Advance Care Directives

Advance Care Directives

Advance Care Directives

Managing end of life decisions can be a challenging time for vulnerable members of our society, so it is crucial to understand what is involved in the advance care planning process.

Find out more about advance care directives, why they are important, who can help you get started, and what happens with your medical care when you can no longer look after yourself.

Let’s take a closer look.

What Is An Advance Care Directive?

An advance care directive is a written document that states your preferences and provides consent for treatment in case of a medical emergency. It ensures that if a person is temporarily or permanently incapacitated, their wishes will be carried out. This may include a decision to refuse life support or medical intervention, even if it would be lifesaving.

Advance care directives only become effective when you cannot communicate your preferences or make decisions for yourself.

If a person is over 18 years and possesses a recognised decision making capacity, their valid advance care directive becomes a legally binding document.

What Is An Enduring Guardian?

An enduring guardian is a trusted friend or relative that you appoint to make decisions for you when you cannot do so yourself.

There is no legal definition of who is a suitable substitute decision maker. Ideally, it should be a person with whom you already have an established and positive relationship. Making health care decisions on another person’s behalf is a big responsibility. Therefore, the person appointed must be responsible and trustworthy.

Decisions made by an enduring guardian could cover areas such as health, services or accommodation. Additionally, they will make decisions that will uphold the values and goals of the person. For example, your enduring guardian can decide where you live, what medical treatment you receive or what services are provided in your home. Your enduring guardian does not make financial decisions, that is the role of an enduring power of attorney.

When Should A Plan Be Made?

It is crucial that advance care planning discussions occur before an urgent medical need or emergency. Having an important conversation about a person’s future health care when they are healthy, can ensure that their wishes are acknowledged.

Several people can benefit from an advance care directive, including patients who have:

  • A chronic health condition
  • Dementia
  • Aged persons
  • Life-threatening illness
  • Neurodegenerative disease
  • People approaching their end of life

What Steps Are Involved?

Decide Who You Want To Be Your Enduring Guardian

Identify who will make medical decisions on your behalf, and explain your wishes for future care. Your nominated enduring guardian can make personal, health and lifestyle decisions if you lose the capacity to do so yourself.

Complete Your Advance Care Directive

Advance Care Planning In New South Wales is fairly straightforward, you do not need to complete a specific form to document your choices. Instead, write down your preferences and sign and date the statement. NSW Health has released a “Making an Advance Care Directive” booklet to support people to write their own, which can make the process easier.

You may wish to include any of the following:

  • Contact details of your nominated enduring guardian
  • Instructional directives that detail your personal preferences
  • Future medical treatments you would accept or refuse, such as tube feeding or resuscitation
  • Values directive, which includes preferences your decision maker must consider before making decisions on your behalf

You may need to stipulate when life-prolonging treatments should be withheld, such as if you have a terminal illness, irreversible brain damage or a severe injury where recovery is unlikely.

Completing An Advance Care Plan On Behalf Of Someone Else

When a person is unable to communicate what they want, a healthcare professional such as a GP or family member can record treatment preferences on their behalf. Although the document is not legally binding, it may be beneficial to understand care decisions in an emergency.

What Resources Are Available To Help With Planning?

Several resources are available to help you start an advance care plan. Health professionals, such as GPs or a treating clinician can initiate and promote future medical care discussions, as a part of routine general practice. 

There are several websites such as; Advance Care Planning Australia and Carers NSW, that contain information about writing an advance care plan. Some include templates with examples to make the process simpler. 

Further information is also available online from various Australian Government departments, health networks and support organisations. Brochures, flyers, fact sheets and resources are available from health care professionals, residential aged care facilities, state trustees and legal organisations. 

The New South Wales Ambulance Service has developed an authorised palliative care plan to assist with transportation to facilities other than hospitals. It also includes authorisation from the patient’s treating medical clinician for care outside the usual ambulance practice and details procedures and pre-authorised medications, which are electronically logged and available for use if needed for a home consult. The palliative care plan ensures that the patient’s wishes are respected at the end of life.

Where Should A Plan Be Stored?

Once completed, your advance care directive records should be uploaded online to my health record. A copy should be given to your GP, enduring guardian, carers, residential aged care facility and close family members.

It is also possible to download and print a health record wallet card, which alerts others that you have an advance care directive. You should also include a copy within your will documentation.

Summary

It is crucial to have a solid understanding of what is involved in the advance care planning process. A plan should include detailed instructional directives detailing things such as; what future medical care you would accept or refuse and any individual preferences.

Advance care directive only become utilised when you cannot communicate your preferences or make decisions for yourself.

When creating your advanced care plan, you must identify your enduring guardian, they should be a trusted friend or relative you appoint whilst you still have the legal capacity to do so.

Several people can benefit from advance care planning and must engage in advance care planning discussions before an urgent medical need or emergency. Such as elderly persons, or someone suffering a serious illness or injury.

Further information is available online from various Australian Government departments, health networks and support organisations.

FAQs

1. Are Advance Care Directives Legally Binding In NSW?

If a person is over 18 years and possesses a recognised decision making capacity, their valid advance care directive becomes a legally binding document.

In situations where a person cannot make decisions or communicate their wishes, a healthcare professional such as a GP or family member can record treatment preferences, this is not a legal document.

2. What Is Included In An Advance Care Plan?

The first step when creating your advance care plan is to identify the person you want to make your future health care decisions, and discuss your wishes for future medical treatment.

Then create your advance care directive. Write down your preferences, and sign and date a statement, or follow a NSW Health guideline.

Your plan should include detailed instructional directives detailing things such as; what future medical treatments you would accept or refuse and personal preferences or values to be acknowledged.

3. How Do I Get An Advance Care Plan?

Several people can benefit from advance care planning and must engage in advance care planning discussions before an urgent medical need or emergency. Write down your preferences, sign and date the document.

There are several websites such as Advance Care Planning Australia and Carers NSW, which contain comprehensive resources and information about writing your advance care plan, many include templates with examples to make the process simpler.

Related articles
Dealing With A Drink Driving Charge In NSW
Dealing With A Drink Driving Charge In NSW

In NSW, a drink driving charge is a serious offense that can have severe consequences. The article provides guidance on Read more

Contributory Negligence
Contributory Negligence

Contributory negligence is a legal principle where a person's own actions or lack of actions contribute to their injuries or Read more

The Legal Right To Silence In NSW
The Legal Right To Silence In NSW

Find out more about your legal rights when remaining silent in a criminal proceeding and the impact the new laws Read more

What is Litigation?
What is Litigation?

The term litigation refers to the process undertaken of handling disputes and bringing to court lawsuits that enforce a particular Read more