1. What is advance care planning (ACP)?
Advance care planning is an on-going process of shared planning for current and future health care. It involves talking about a person’s values, beliefs and preferences so they can guide decision making when the person cannot make or communicate their decisions.
2. Who needs to do advance care planning?
Everyone should consider advance care planning , regardless of their age or health. It can be particularly important to individuals such as people with an advanced chronic illness, a life limiting illness, are aged 75+ years or at risk of losing competence.
3. What is an advance care directive?
It is a type of written advance care plan recognised by common law or specific legislation that is completed and signed by a competent adult. It can record the person’s preferences for future care, and appoint a substitute decision-maker to make decisions about health care and personal life management.
4. When is an advance care directive used?
These are only used if a person is unable to make or communicate their decisions. The directive would then be used to guide the decisions made by the medical staff in consultation with an appointed substitute decision maker if one has been nominated, and family.
5. Why is it helpful to make an advance care directive?
Completing an advance care directive often reassures individuals and their families as they have a clear idea of what is desired by the person in the event of illness or injury.
6. Is advance care planning the same as euthanasia?
No, there are very significant differences between advance care planning and euthanasia. Advance care planning is the process of discussing and choosing future health care and medical treatment options. It is about people making decisions about their own medical treatment including refusing treatment. Euthanasia is the practice of intentionally ending life in order to relieve pain and suffering. Euthanasia is currently illegal in Australia.
7. Is a doctor required to complete an advance care directive?
Ideally an advance care directive should be discussed with a doctor as this ensures that any decisions made are informed by health and other information as it specifically relates to the individual. It also ensures that the treating doctor is fully aware of the person’s preferences and therefore better able to provide medical care that takes these preferences into account.
8. Is a lawyer required to complete an advance care directive?
No, the law does not require a lawyer to complete an advance care directive. A doctor or someone experienced in advance care planning can help to complete the required documents.
9. Who can the person choose/nominate as a substitute decision-maker?
A substitute decision-maker (SDM) is expected to act in the person’s best interests and make the same decisions they believe the person would have made. A substitute decision-maker should be:
- someone you trust
- someone who will listen carefully to your wishes and values
- available (ideally live in the same city or region)
- over the age of 18
- prepared to communicate clearly and confidently on your behalf when talking to your doctors, other health professionals and family members.
10. What authority does a substitute decision-maker have?
There are some differences between Australian states, but generally a substitute decision-maker can consent to medical treatment on the person’s behalf if they lose capacity. In some states, they can also legally refuse medical treatment if the person has made their preferences known.
11. Can an advance care directive be changed or revoked?
Yes, it can be changed or revoked while the person still has capacity. It is best to make a new advance care directive and destroy any old ones. Ensure that those who had a copy of the previous directive receive a copy of the new directive.
12. Does an advance care directive still apply if the person is interstate?
If a person has discussed their preferences with a substitute decision-maker and family, then they will be able to give information regarding the person’s preferences to the doctors who will contact them to discuss the situation if the person loses the capacity to make decisions. The substitute decision-maker and family will also be able to give the advance care directive to the treating doctors. There is variation regarding interstate recognition of SDMs.
13. What happens in an emergency?
In an emergency, doctors will make medical decisions, taking into account the person’s preferences, whether they were expressed in an advance care directive or verbally to the substitute decision-maker and family. If the advance care directive is not immediately available, life-prolonging measures may be started until the treating doctors can hold discussions with the substitute decision maker/family regarding expressed preferences.
14. How does a hospital know that I have an advance care plan?
The hospital needs to be informed that you have an advance care plan. You or your substitute decision maker usually informs them on your admission. Some hospitals may have provision for the scanning of your key documents into your electronic records.
15. What happens if a person does not have an advance care plan?
In the event of serious illness doctors will make treatment decisions based on their assessment of the best interests of the person. This may include treatments that the person would not want.
16. Does a person have the right to refuse medical treatment?
Yes, a person can legally refuse treatment before or after it has been commenced. In some states, nominated substitute decisions makers can also refuse treatment on behalf of the person who has lost capacity.
17. Is the information confidential when written down?
No. The whole idea of advance care planning is that you make your wishes known to your family, doctors etc so that they can be respected. You do have the right to not inform your family of your wishes if you have appointed a substitute decision-maker and have informed them of your wishes but in that case documenting your wishes would certainly be advisable as there could be disputes and problems. If you wish your wishes to be respected then it is recommended that you inform your family etc.