What is an Advance Care Directive and Do I Need One?

An Advance Care Directive is one of the most important documents most Australians never get around to completing. It takes a few hours, costs nothing in most states, and could spare your family one of the most agonising decisions they'll ever face.

What is an Advance Care Directive?

An Advance Care Directive (ACD) — also called an Advance Health Directive, Advance Personal Plan, or similar names depending on your state — is a legal document that records your wishes about future medical treatment. It tells doctors and family members what care you would and wouldn't want if you were unable to speak for yourself.

It can also name a substitute decision-maker — someone authorised to make medical decisions on your behalf if you lose capacity.

What can it cover?

An Advance Care Directive can address a wide range of situations and treatments, including:

• Whether you want life-sustaining treatment if there is no reasonable prospect of recovery
• Your wishes about resuscitation (CPR)
• Whether you want to be kept on a ventilator or other life support
• Your preferences about pain management and palliative care
• Where you would prefer to die — at home, in a hospice, in hospital
• Refusal of specific treatments for religious, cultural or personal reasons
• Any other wishes about the care you receive

What it cannot do

An Advance Care Directive cannot request treatment that a doctor considers futile or harmful, and it cannot request euthanasia or assisted dying (though separate legislation governs voluntary assisted dying in most Australian states now). It also cannot override decisions made by a legally appointed substitute decision-maker who has conflicting authority.

Who should have one?

Every adult. You don't need to be elderly or unwell to complete one. Accidents and sudden illness can affect anyone at any age. Without an ACD, medical decisions in a crisis may be made by doctors based on general medical guidelines, or by family members who may not know — or may disagree about — what you would have wanted.

An ACD is particularly important if:

• You have a chronic illness, terminal diagnosis, or are in declining health
• Your family members might disagree about your care
• You have strong views about life-sustaining treatment
• You have religious or cultural preferences about medical treatment
• You live alone or are estranged from family

How to complete one in Australia

The process varies by state. In most states, you can download the form from your state health department's website, complete it yourself, and have it witnessed. Some states require a doctor or pharmacist to witness the document. A lawyer can help but is not required in most cases.

• NSW: No prescribed form — a written document signed and witnessed by two adults
• VIC: Advance Care Directive form available from the Department of Health — must be witnessed by a medical practitioner or nurse
• QLD: Advance Health Directive form from Queensland Health — must be witnessed by a doctor
• SA: Advance Care Directive form from SA Health — witnessed by two eligible witnesses
• WA: Advance Health Directive from WA Health — must be witnessed by a doctor or JP
• TAS: Written document signed and witnessed
• ACT: Advance Care Planning Document — available from ACT Health
• NT: Advance Personal Plan — from the Office of the Public Guardian

Where to store it

Give a copy to your GP to keep on file. Give a copy to anyone you've named as a substitute decision-maker. Keep the original somewhere accessible at home — not locked in a safe deposit box where it can't be found in an emergency. Tell your family it exists and where to find it.

Can you change it?

Yes. You can update or revoke an Advance Care Directive at any time while you have mental capacity. If your wishes change — or your circumstances do — update it. Make sure old versions are destroyed and replaced with the new one.