Advance care planning (ACP) is becoming an increasing health priority in an environment where the Australian population is rapidly ageing and people are seeking greater control over the way they live and die. Personal choice and agency in our medical treatment is fundamental to our right to live autonomously and with dignity.
Voluntary assisted dying (VAD) is a sensitive and complex topic that continues to generate strong community interest, rigorous debate and diverse views. While VAD and ACP are separate actions, in the broader community the two are often conflated. This position statement seeks to clarify key points of difference and present the position of Advance Care Planning Australia (ACPA).
ACPA defines advance care planning as a coordinated communication and medical planning process between a person, their family, carers and/or treating healthcare team. Advance care planning aims to clarify the person’s values, beliefs and preferences for medical treatment should the person lose their capacity to make or communicate decisions in the future. A person can choose to consent to, refuse and/or withdraw from future medical treatment. A person can also appoint a substitute decision-maker.
ACPA believes advance care planning should be available and promoted to all Australians. Advance care planning supports a person’s rights by promoting autonomy and control over medical treatment decision-making.
Ideally, the person’s preferences for care and/or appointment of their substitute decision-maker should be documented in an Advance Care Directive (ACD). An ACD is completed and signed by a competent adult, but only comes into effect when the person loses capacity to make medical decisions. (In Victoria, children with decision-making capacity can also complete an ACD). All health professionals have obligations to implement ACDs and support quality palliative and end-of-life care. Please refer to the diagram below.
Diagram: ACP Across the Life Stage Continuum © Austin Health 2019
Voluntary assisted dying is defined as allowing a competent person in the late stages of advanced disease to end their life at a time they choose by taking a medication prescribed by a doctor, or in limited circumstances, have medication administered by a doctor.
Voluntary Assisted Dying is not permitted in Australia, with the exception of in Victoria where the Voluntary Assisted Dying Act 2017 came into effect on 19 June 2019. Only people who meet the strict eligibility requirements and follow the steps set out in the Act can access voluntary assisted dying.
In Victoria, a person cannot make a request for VAD in their Advance Care Directive and their substitute decision-maker is not able to request VAD on their behalf.
Advance Care Planning Australia’s position is that:
- ACPA is about advance care planning and directives, and not about Voluntary Assisted Dying
- the laws of each Australian jurisdiction are to be respected and upheld
- a diversity of views on VAD (both in the community and among health professionals) should be respected
- every Australian should have access to acp and their preferences should be respected
- VAD is not a substitute for access to high-quality advance care planning and palliative care services.
Victoria’s restrictive eligibility criteria means most Victorians will not have access to VAD, so referrals to advance care planning and palliative care should be offered, where appropriate.
Advance care planning offers the best chance of an individual safeguarding and actively controlling their future care treatment. It is available to all adults (and children in Victoria) and individuals can make directives ahead of time to guide their care at a future time, when they are unable to make their own medical treatment decisions (eg dementia).
ACPA strongly recommends:
- people write their ACDs early and document their future care preferences, before loss of decision-making capacity occurs
- health professionals upskill in advance care planning to better support an ageing population, people with chronic illness and those facing end-of-life
- health professionals are supported to better distinguish between expressions of suffering and a genuine request for VAD
- policy efforts are directed towards increasing uptake of advance care planning which is currently less than 15% of the adult population and around 30% of older Australians.
Find more information about voluntary assisted dying in Victoria.
Find advance care planning forms for your state or territory.
 White B, Tilse C, Wilson J, et al. Prevalence and predictors of advance directives in Australia. Internal medicine journal. 2014; 44: 975-80.
 Detering K, Buck K et al. Prevalence and correlates of advance care directives among older Australians accessing health and residential aged care services: multicentre audit study