Record your choices

Advance care planning documents

The documents you can use to record your choices for future health care are different in each state and territory. They have different names, but they help you do similar things:

• record your values and preferences
• make specific instructions to consent to, or refuse certain medical treatments
• appoint a substitute decision-maker you’ve chosen to speak for you.

Some documents, like advance care directives and forms to appoint a substitute decision-maker, are legally binding. You must have decision-making capacity to complete these forms. This means you can make and communicate your decisions. Find out more about advance care planning and the law.

Advance care planning documents only take effect if you don’t have capacity to make health care decisions for yourself.

Advance care planning for children and young people

Children and young people under 18 can do advance care planning, however, their options for documents are more limited.

Victoria has an advance care directive for people under 18 which includes a section for legally binding instructions. In Tasmania, a person can complete an advance care directive from the age of 16. Queensland has a form for children and young people to express their views, wishes and preferences. This is not legally binding, but can support substitute decision-makers and health professionals make choices about care if the young person can’t make or communicate decisions.

A person under 18 can’t appoint a decision-maker.

Each state and territory have principles for good practice when obtaining consent from a child or young person about health care or medical treatment. You should refer to your local health service or GP for more information.

Some states and territories have local support services to assist with advance care planning. You’ll find this information on the relevant state and territory pages.

Resuscitation plans

This section explains what resuscitation plans are, how they are used, and how they relate to advance care planning. Resuscitation plans are not ACP documents, because they are clinical documents created by healthcare professionals, not written by the person themselves. But they can play an important role in helping to make sure that a person’s wishes and preferences are respected.

Since there is not much information available to the public about resuscitation plans, ACPA has provided this information to help clear up confusion about resuscitation plans and how they relate to advance care planning.

What is a resuscitation plan?

A resuscitation plan is a medical plan (or clinical document) about what to do if a person suddenly becomes very unwell. Resuscitation plans focus on whether, or in what circumstances, life-prolonging treatments should be provided. Cardiopulmonary resuscitation (CPR) is the most common treatment included in these forms, but they can also include other types of treatments and other information. Their purpose is to help health care staff know what to do in an emergency when time is critical and you are not able to speak for yourself.

There are standard forms used in some health systems, with names such as:

• Acute Resuscitation Plan (ARP) (Qld)
• Resuscitation Plan (NSW)
• Resuscitation Alert – 7-Step Pathway (SA)
• Goals of Patient Care form (WA)
• Medical Goals of Care form (Tas)

Resuscitation plans are a type of “goals of care” document. Goals of care documents may be used across care settings. Resuscitation plans outline the level of intensity of medical treatment to be provided:

• Full active treatment
• Treatment for reversible issues but not intensive interventions
• Comfort-focused care

If the focus is comfort, a resuscitation plan describes how symptoms like pain or breathlessness will be managed.

What’s the difference between a resuscitation plan and an advance care directive?

Why do I need a resuscitation plan if I have an advance care directive?

A resuscitation plan is a communication tool to help make sure that, no matter who is looking after you, everyone has clear instructions for what to do if you suddenly become very unwell, if you can’t speak for yourself. It provides clear clinical instructions and medical authorisation for other health professionals (for example ambulance officers) to provide appropriate care for you quickly. In other words, it can help put the instructions in your advance care directive into action quickly and easily.

Why do I need an advance care directive if I have a resuscitation plan?

The reasons why an advance care directive or other advance care planning document can be useful even when there is a resuscitation plan in place include:

• To capture your wishes and preferences about other aspects of health care rather than just specific treatments, for example, your preferred place of care.
• To have specific instructions recognised by health professionals in settings that resuscitation plans may not be recognised.
• To guide decisions about health care other than life-sustaining treatments. Advance care directives include more information about what’s important to you and what outcomes you want to avoid. This can be helpful for your substitute decision-maker/s when making decisions about health care other than life-sustaining treatments.
• To appoint your chosen substitute decision-maker (in some states and territories).

Why is my resuscitation plan different to my advance care directive?

Sometimes a person has an advance care directive with instructions that they want to have CPR or other life-prolonging treatments, but a resuscitation plan is prepared which says CPR or other life-prolonging treatments will not be provided. This can be confusing.

The reason a resuscitation plan may not match a person's advance care directive is that the doctor considers that life-prolonging treatments such as CPR would be unlikely to work or may cause harm, given a person’s current state of health.

Resuscitation plans take account of a person’s wishes and preferences, as well as what the doctor thinks is medically realistic and appropriate for them at the time. Doctors will make recommendations for treatments based on the person’s medical condition/s, how likely they are to benefit, and good medical practice. Treatments that are very difficult for the person and might cause more harm than help are sometimes called 'futile' or 'non-beneficial'. Learn more about Futile and non-beneficial treatment.

What is shared decision-making for resuscitation plans?

Resuscitation plans should be developed through shared decision making. This means the doctor should:

• Make sure you understand your current health condition/s and what’s likely to happen in the future
• Explain what treatments may realistically help you, and what may not, including the risks or possible complications of treatments
• Ask about your wishes and preferences and what is important to you in relation to your health care, important people in your life, culture, spirituality etc.
• Ensure you have access to support as required – interpreter, supported decision-making strategies, cultural liaison, etc
• Explain what they recommend
• Explain what care can and will be provided.

What if I have concerns about my resuscitation plan?

Talk to your doctor as soon as possible.