What is an Advance Care Directive?
An advance care directive records what medical care you would want if you could not make or communicate your own decisions later.
An advance care directive records what medical care you would want if you became too unwell to make or communicate your own decisions. It can help doctors, nurses and the people close to you understand what matters to you, what treatment you would refuse, and who should speak for you.
General information: This page gives general information for people in Australia. Advance care directive law differs between states and territories. It cannot tell you whether one document is valid in your situation. If you are making decisions now, ask your doctor, palliative care team, hospital, aged care service or a lawyer for advice about your state or territory.
Why people make one
People often make an advance care directive because they do not want their family to guess during a crisis. It can also help if family members disagree, if a hospital transfer is being discussed, or if there are treatments you would not want near the end of life.
Without this, family or carers may make decisions that do NOT align with your wishes, and if you are unable to tell others at the time you may receive, or not receive, care that would go against your wishes.
The document may cover things such as CPR, breathing machines, tube feeding, IV fluids, blood transfusions, surgery, antibiotics, hospital transfer, dialysis, chemotherapy, comfort care and where you would prefer to be cared for.
It can also record values rather than only treatment names. For example, some people want every treatment that might give more time. Others would not want treatment if it could not help them return to a level of awareness, independence or comfort that matters to them.
It only matters if you cannot decide
If you can understand the decision, weigh the options and communicate a choice, you make your own decision. Your current decision usually overrides an old document.
An advance care directive becomes important when you cannot make or communicate the relevant decision. This might happen after a stroke, severe infection, accident, advanced dementia, delirium, heavy sedation, or during the final stage of illness.
The name changes across Australia
The broad idea is similar, but the legal documents are not the same everywhere. Depending on where you live, you may hear terms such as:
- Advance Care Directive
- Advance Health Directive
- Health Direction
- Statement of Choices
- Advance Personal Plan
- Enduring Power of Attorney
- medical treatment decision maker
- enduring guardian
- substitute decision-maker
New South Wales is different because it does not have a statutory advance care directive form in the same way most other states and territories do. NSW recognises common law advance care directives when they are valid, but there are still templates available (see below).
What it can and cannot do
An advance care directive can usually record refusals of future treatment. In some places it can also record consent to future treatment, values, preferences, and appointment of a person to decide for you.
It cannot force doctors to give treatment that is not clinically appropriate. It cannot be used to request voluntary assisted dying (VAD) for later. VAD laws require the person to have decision-making capacity at the required stages of the VAD process.
If you are thinking about VAD, an advance care directive can still be useful. It can record what care you would want if you became too unwell to continue the VAD process, or if you later chose not to use VAD.
The conversations matter
The form is only one part of advance care planning. The people who may need to use it should know it exists and understand what you meant.
It helps to talk with:
- your GP or specialist
- your palliative care team
- the person you want to speak for you
- family or close friends who may be present in a crisis
- your aged care home or home care provider, if relevant
Give copies to the people and services that may need it. Many people also upload a copy to My Health Record. Some states and territories have their own health record, register or recommended storage process.
Choose your state or territory
Because the rules differ, use the page for where the document is being made or where care is likely to happen:
- New South Wales advance care directives
- Victoria advance care directives
- Queensland advance health directives
- South Australia advance care directives
- Western Australia advance health directives
- Tasmania advance care directives
- ACT advance care planning, health directions and enduring powers of attorney
- Northern Territory advance personal plans
You may also want to read
- Can I request VAD in an advance care directive?
- Can I refuse antibiotics, hospital transfer, tube feeding or other treatment in advance?
- Who decides when family members disagree about end-of-life care?
- What happens if the family disagrees about treatment at the end of life?
Sources and further information
- Advance care planning - healthdirect
- Advance care planning - Australian Government Department of Health, Disability and Ageing
- Advance care planning and the law - Advance Care Planning Australia
- Advance Care Directives - End of Life Law in Australia
- National framework for advance care planning documents - Australian Government Department of Health, Disability and Ageing