Advance care planning provides an opportunity for people to think, discuss and plan for the medical treatment they would prefer if they became too ill in the future to express their wishes.
Yes, you can legally refuse treatment or ask for some types of treatment to be withdrawn. In some jurisdictions, nominated substitute decison makers can also refuse treatment on your behalf if they know or believe that to be your wish.
An advance care directive is a written record of a person's preferences for future care, which is recognised by common law or specific legislation. It is completed and signed by a competent adult. In a separate dcoument, a substitute decision maker may be appointed to make decisions about health care and personal life management if you were no longer able to do this for yourself.
Advance care directives only become effective if a person is unable to make or communicate their own decisions concerning their medical care. The directive would guide the decision making of medical staff, substitute decision maker (if appointed) and family.
Any person over 18 years of age can make an advance care directive, unless they are already unable to make their own decisions about medical treatment due to a disability, illness or injury. Advance care directives are particularly relevant to people who:
- Have multiple or complex medical problems
- Are elderly or frail
- Are approaching end of life
- Are isolated or vulnerable
- Have cognitive impairment
- Are relatively healthy but keen to plan for future healthcare
No, a lawyer is not required to complete an advance care directive. Your doctor or someone experienced in advance care planning can help you to complete this document.
Ideally you should discuss your advance care directive with your doctor and those responsible for your care. This means that any decisions you make will be made on current, accurate and objective information.
- Those close to you in knowledge, care and affection. This may include biological family, family of acquisition (by marriage or contract) and family and friends of choice. Loved ones don't necessarily know or understand your preferred wishes in relation to future medical care.
- Those involved in the current care of your health. This may include your general practitioner, specialist, practice or community nurse, social worker etc. Talking to those involved in your health care can help you to understand your current health and what you may need in the future. They can also provide information about the potential outcomes of medical treatment.
- You may also wish to speak to your religious, spiritural or cultural advisor, if applicable.
What is a substitute decision maker?
A substitute decision-maker is a person appointed or identified by law to make a decision on behalf of a person who cannot make or communicate decisions.
There are some differences between Australian states and territories, but generally substitute decision makers can consent to medical treatment on your behalf if you are unable to do so yourself. In some jurisdictions, they can also legally refuse medical treatment on your behalf. A substitute decsion maker has no authority to act while you havee decision making capacity.
- Is eighteen years of age or over
- Knows you well
- You trust to act in your best interests and to make decisions you would have made for yourself
- Will be able to make decisions under potentially difficult situations
- Is willing to take on this role
- Is not your paid carer
Some jurisdictions allow for more than one substitute decision maker to be appointed.
If you are unable to make or communicate decisions about your own healthcare then a hierachy of appropriate people including spouse / partner, carer or nearest relative is employed. The first person in the order of the list who is available, willing and able to make medical decisions on behalf of the person is considered the 'person responsible' and can provide consent.
If you have discussed your wishes with your substitute decision maker and family, they will be able to pass on this information to medical staff as they will be the ones contacted to discuss your condition.
They will also be able to provide your advance care directive to whoever is responsible for your care. While the legislation varies from different jurisdictions if an advance care directive exists then this is likely to be taken into consideration when medical decision making is involved.
When there is an emergency and your advance care directive is available, medical decisions will be made by reviewing your wishes and discussing your situation with your substitute decision make and family.
If your directive is not immediately available, life-prolonging measures may be started until medical staff can contact your family. If it is clear after discussions with your substitute decision maker and family that you would not want life prolonging treatments or the likely outcomes associated with these then treatments would be stopped, however ongoing care would still continue.
If you become unwell and cannot communicate for yourself, doctors will make medically related decisions based on your best interests. This could include treatments that you might not want or outcomes that are not acceptable to you. Your family may find it extremely distressing trying to make decisions 'in your best interests' without being informed of your wishes. If your feel strongly about certain types fo treatments that you would not want to receive, then an advance care directive is a good way to communicate those wishes.
No, currently there is no nationaly registry for advance care directives. However you can share this information in your My Health Record which is a secure online summary of your health information where you control what goes into it and who is allowed to access it.