In these uncertain times, advance care planning is now more important than ever as many Australians face the prospect of suddenly becoming unwell with COVID-19. This situation may result in changes to a person’s future healthcare preferences.
Older Australians are most at risk of serious illness and COVID-19 infection, in particular those with existing conditions such as lung and heart disease, cancer and diabetes.
Creating a plan during COVID-19
COVID-19 restrictions create difficulties in getting advance care directives signed by the appropriate people and your doctor. However, these documents can be completed with and signed by your doctor if you have email or fax available.
Alternatively, all states and territories (excluding Queensland) recognise common law advance care directives. This means that if you document your preferences in writing and provide your signature they will be legally valid. To do this, you could use the usual
advance care directives from your state or territory or by creating a letter.
These should include your:
date of birth
preferences for care
preferences for life-prolonging treatments
acceptable or unacceptable outcomes
signature and date.
Your advance care planning and COVID-19
We recommend you consider your future health preferences and take some actions at this time.
Start a conversation with loved ones about advance care planning – be clear about what you would want or not want. Identify who should make your medical decisions if you become suddenly unwell.
Speak with your doctor about advance care planning and your preferences, particularly if you are wanting less treatment. Consider doing this via a telehealth consultation.
Write down your preferences in an
advance care directive. Get advice
National Advance Care Planning Service on 1300 208 582 for more information about COVID-19 and advance care planning. We're available 9am – 5pm, Monday – Friday (AEST).
Use these prompts to help start conversations with loved ones about advance care planning.
The COVID-19 situation has made me think about what health care I would want if I got really sick, can we talk about this?
It's important to me that I can make choices about my future health care. Can I tell you about my preferences and what I want and don't want?
I have just updated my Will and it has made me think about my future health care. Can I tell you about my preferences and what I want and don't want?
Now that I have been diagnosed with this condition, I would want to make sure that we know each other's preferences for care. Can we talk about this?
Can we talk about your health and the COVID-19 situation? I want to know more about what's important to you.
If you became sick and I had to make a medical treatment decision for you, what would you want me to say or do?
Would you be willing to be my substitute decision-maker, if I can't make my own medical treatment decisions?
There may come a time where you become too sick to make your own medical treatment decisions. It would be a good idea to be prepared and to choose the person you would like to be your substitute decision-maker.
The news reports about people getting COVID is pretty scary. I want to talk to you about what I would want to happen if I got sick.
COVID-19 and health professionals
Advance care planning is an important part of Australia’s COVID-19 healthcare planning. The
Australian Health Sector Emergency Response Plan for Novel Coronavirus (COVID-19) cites the importance of advance care planning documents as part of a coordinated response.
We recommend healthcare professionals and providers to encourage patients with decision-making capacity to:
think about and discuss their future healthcare preferences with loved ones and their treating medical practitioner
identify their substitute decision-maker(s). Appoint these when relevant and make this known to their treating medical practitioner or service
make their existing advance care directive available and store them in their My Health Record
record their preferences of
life-prolonging treatments (e.g. CPR, ventilation) in their advance care directive record their preferences regarding acceptable and unacceptable outcomes (e.g. how much independence they are willing to lose) in their advance care directive
We also recommend healthcare professionals and providers:
identify and assist high-risk patients who may want less treatment to document their health and care preferences in an advance care directive, service care plan and/or medical order
use documents which can be completed and signed using email or fax when conducting a COVID-19 telehealth advance care planning consultation
store the individual’s substitute decision-maker details and advance care directive in the patient's My Health Record
Aged care providers
We urge aged care providers to include advance care planning in their management of COVID-19.
Aged care providers have obligations under the Aged Care Quality Standards. Standard 2, Requirement (2)(b) specifies that assessment and planning identifies and addresses the consumer’s current needs, goals and preferences, including advance care planning and end-of-life planning if the consumer wishes.
We urge general practitioners to include advance care planning in their management of COVID-19.
General practitioners usually have ongoing and trusted relationships with their patients and are well-positioned to initiate and promote advance care planning. General practitioners may want to support their patients to do advance care planning during COVID-19. A
RACGP Advance Care Planning Position Statement is available.
Read our news story for
more information about COVID-19 for general practitioners. Health service providers
Health service providers have obligations under the National Quality and Safety Standards (Standards 2 and 5) to implement advance care planning. This is especially relevant during COVID-19.
COVID-19: advance care planning for general practitioners
This webinar discusses the key advance care planning priorities and actions for general practitioners during COVID-19. It covers ethical considerations, advance care planning in diverse communities, the challenges of signing documents and more.
COVID-19: advance care planning for aged care
Listen to industry experts discuss key advance care planning priorities and actions for the aged care sector during COVID-19. This webinar covers the current challenges, ethical considerations and more.
COVID-19: advance care planning and healthcare professionals
This webinar covers key advance care planning information and considerations for healthcare professionals during COVID-19. Hear from sector experts including intensive care leaders, A/Prof Charlie Corke and Dr Peter Saul and more.
Use these prompts to help start the conversation with patients about advance care planning.
You mentioned you were concerned about what would happen if you got the virus. Would you like to talk about this some more?
How are you going with your isolation? What do you think would happen if you got COVID-19?
Because of your severe lung (heart/kidney/cancer etc) disease, you are more likely to get really sick if you got the virus. Have you thought about this?
I like to talk to my patients about what medical treatment they would want if they became unwell with COVID-19. It's such a challenging situation. Have you thought about this?
Can we talk about your future health care and any preferences you have?
COVID-19 can cause people to become suddenly and seriously unwell, requiring intensive treatment in hospital. This is often for a long period and unfortunately, many won't recover. Many older people prefer to limit certain treatments such as CPR or being placed on a ventilator. What are your thoughts about this?
You just told me that if you got COVID-19 you would not want to go to hospital. Can we talk about what that may mean and how we can support you to stay at home? What does it mean to you to live well? What are your values, beliefs or preferences about medical treatment?
Have you thought about what medical treatment or health outcomes are acceptable or unacceptable to you?
Would you want to be transferred to hospital if you became unwell or would you prefer to stay here?
Have you spoken with your family about your choices?
Who would you trust to make your medical treatment decisions if you were unable to talk due to illness? What would you like them to say?
Do your loved ones know your preferences? I encourage you to discuss these with them.
It is really helpful for you and your family to discuss what you would want to happen if you got really sick.
would you be willing to document your preferences and values in an advance care directive? This can help others to know what you want if you can't say so in future.