An Advance Care Directive (ACD) is a legal document that outlines your preferences for future medical care should you become unable to communicate or make decisions. In Australia, these important documents help ensure your wishes are respected while reducing stress for loved ones facing difficult healthcare decisions on your behalf. This comprehensive guide explores how to create a valid Advance Care Directive in Australia, including state-specific requirements, essential elements to include, and the proper procedures for ensuring your directive will be followed when needed.
What Is an Advance Care Directive and Why It Matters
An Advance Care Directive is a legally recognised document that allows you to specify your healthcare preferences in advance, particularly for end-of-life or serious illness situations where you may lose decision-making capacity. It serves as your voice when you cannot speak for yourself.
According to Advance Care Planning Australia, these documents are fundamental components of advance care planning—a broader process that involves thinking about, discussing, and documenting your healthcare preferences. While conversations with loved ones are valuable, formally documenting your wishes provides clearer guidance to healthcare professionals and family members during critical situations.
ACDs can address various aspects of medical care, including:
Life-sustaining treatments you would accept or refuse
Specific medical interventions you consent to or decline
Quality of life considerations that should guide treatment decisions
Values and beliefs that should inform your care
Appointment of a substitute decision-maker (sometimes called a medical treatment decision-maker)
Research from the Australian Department of Health shows that having an ACD in place significantly reduces family distress when making medical decisions, increases the likelihood that your wishes will be respected, and often leads to care that better aligns with your personal values and preferences.
State-by-State Requirements for Validity
Australian Advance Care Directive requirements vary significantly between states and territories, making it essential to follow the specific guidelines for where you live.
New South Wales
In NSW, Advance Care Directives are recognised under common law rather than specific legislation. To be valid:
You must have decision-making capacity when creating the document
The directive should be clear and specific about treatments
It should be current and relevant to your situation
Ideally, it should be discussed with your GP and regularly updated
Forms and guidance are available through NSW Health, though you're not required to use a specific form.
Victoria
Victoria has formal legislative recognition for ACDs under the Medical Treatment Planning and Decisions Act 2016. Requirements include:
You must be an adult with decision-making capacity
The document must be witnessed by two adults, including one medical practitioner
It can include instructional directives (specific instructions) and/or values directives (general preferences)
Official forms are available through Better Health Channel
Queensland
In Queensland, ACDs are governed by the Powers of Attorney Act 1998. Valid directives must:
Be completed on the official form
Be signed by the person and a doctor who confirms capacity
Include a certificate signed by a doctor confirming the person understood the document
Be witnessed by an eligible witness (such as a JP, lawyer, or notary public)
Forms are available through Queensland Health.
South Australia
South Australia's legislation provides for several advance care planning documents under the Advance Care Directives Act 2013:
Must use the official form
Requires at least one independent witness
Can appoint one or more substitute decision-makers
Must include a statement that you understand the implications
Forms and information are available through SA Health.
Western Australia
Western Australia's framework falls under the Guardianship and Administration Act 1990:
Must be in writing
Must be signed by the person and two witnesses
Neither witness can be a beneficiary or immediate family member
One witness must be a person authorised to witness statutory declarations
Information and forms are available through WA Health.
Tasmania
Tasmania recognises Advance Care Directives through common law principles. While there is no specific legislation:
The directive should be in writing
Should be signed and dated
Ideally witnessed
Should be regularly reviewed and updated
Forms and guidance are available through Tasmanian Department of Health.
Northern Territory
The NT recognises Advance Personal Plans under the Advance Personal Planning Act 2013:
Must be in the approved form
Signed by the person making it
Witnessed by an authorised witness who confirms capacity
Can include both treatment decisions and values statements
Forms are available through NT Health.
Australian Capital Territory
The ACT's Health Records (Privacy and Access) Act 1997 recognises Advance Care Planning documents:
Should be in writing
Should be signed and dated
Ideally witnessed
Should include specific treatment instructions where possible
Forms and information are available through ACT Health.
Essential Elements to Include in Your Directive
Regardless of your state or territory, certain core elements make an Advance Care Directive more effective and comprehensive.
Personal Information
Ensure your document clearly identifies you with:
Full legal name
Date of birth
Current address
Medicare number
Contact details
GP information
This basic information helps healthcare providers verify they're referring to the correct directive.
Medical Treatment Preferences
This section forms the heart of your directive, addressing specific treatments you would accept or refuse:
Life-sustaining treatments:
Cardiopulmonary resuscitation (CPR)
Mechanical ventilation
Artificial nutrition and hydration
Kidney dialysis
Antibiotics for life-threatening infections
Specific conditions: Consider addressing preferences for common serious conditions:
Severe stroke with significant disability
Advanced dementia
Permanent unconsciousness (persistent vegetative state)
Terminal illness
Severe, irreversible brain injury
Pain management and comfort care: Specify your wishes regarding:
Pain medication, even if it might hasten death
Palliative sedation for uncontrollable symptoms
Comfort measures and quality of life priorities
Palliative Care Australia recommends focusing on outcomes rather than specific medical procedures when possible. For example, instead of just refusing ventilation, explain the quality of life you would find acceptable or unacceptable.
Values and Beliefs Statement
This section provides context for interpreting your specific medical wishes:
Religious or spiritual beliefs affecting medical decisions
Cultural considerations important to your care
Quality of life factors most important to you
What gives your life meaning and purpose
Circumstances you would find worse than death
Research from the Medical Journal of Australia shows that values statements help guide decisions in situations you might not have specifically anticipated.
Appointment of Substitute Decision-Maker
In most states, you can appoint someone to make medical decisions if you cannot:
Full name and contact details of your primary decision-maker
Full name and contact details of alternate decision-makers
Specific powers granted to your decision-maker
Any limitations on their decision-making authority
Whether they can access your medical records
Ensure this section aligns with your state's specific requirements, as some states require separate forms for appointing decision-makers.
Special Requests and Preferences
Consider including:
Preferred place of care (home, hospital, hospice)
Cultural or religious rituals important during illness or after death
People you would want to be present (or not present)
Music, readings, or environmental preferences
Organ and tissue donation wishes
Witness Statements and Signatures
Follow your state's specific requirements for:
Number of witnesses required
Qualifications needed for witnesses
Specific witness declarations
Placement of signatures
Dating requirements
Secure storage solutions for your directive
Having a well-crafted Advance Care Directive is only effective if it can be located when needed. Consider these storage and accessibility approaches:
Personal Storage Options
Keep copies in logical locations:
With your important documents at home (clearly labeled)
In your refrigerator in a clearly marked envelope (paramedics often check there)
In your wallet or purse (a card indicating you have an ACD)
Digital copies in secured but accessible cloud storage
With trusted family members or close friends
Medical Record Registration
Ensure your directive is available to healthcare providers:
Register it with your GP and specialists
Upload to My Health Record (Australia's national electronic health record system)
Provide copies to your local hospital if you have chronic conditions
Consider private digital storage with emergency access features
Include with pre-admission paperwork for planned hospitalizations
Official Registration Systems
Several states offer official registration systems:
South Australia: Advance Care Directive Registry
Northern Territory: Advance Personal Plan Register
ACT: Health Record (through your healthcare provider)
Even in states without official registries, ensure your directive is:
Noted in your My Health Record
On file with your regular healthcare providers
Known to your substitute decision-maker
Accessibility Considerations
Ensure your directive can be accessed when needed:
Tell family members and close friends where copies are stored
Provide your substitute decision-maker with multiple copies
Consider a QR code linking to a digital copy (for wallet card)
Review storage locations annually to ensure accessibility
Update all stored copies when you make changes
Advance Care Planning Australia recommends maintaining a list of everyone who has a copy of your directive to facilitate updates if you make changes.
Template: Basic Advance Care Directive Framework
While you should use your state's official form when available, this template provides a general framework for understanding the key components of an Advance Care Directive:
ADVANCE CARE DIRECTIVE
1. PERSONAL DETAILS
Full Name: [Your full legal name]
Date of Birth: [DD/MM/YYYY]
Address: [Your current residential address]
Medicare Number: [Your Medicare number]
Contact Number: [Your phone number]
GP Name and Contact: [Your doctor's details]
2. CAPACITY STATEMENT
I, [Your Name], make this Advance Care Directive voluntarily and understand that it will be used to guide my medical care if I become unable to make or communicate decisions. I am over 18 years of age and have decision-making capacity at the time of signing this document.
3. APPOINTMENT OF SUBSTITUTE DECISION-MAKER (if applicable in your state)
I appoint the following person(s) to make medical treatment decisions on my behalf if I am unable to do so:
Primary Decision-Maker:
Name: [Full name]
Relationship: [Relationship to you]
Contact: [Phone and email]
Alternate Decision-Maker (if primary is unavailable):
Name: [Full name]
Relationship: [Relationship to you]
Contact: [Phone and email]
4. MEDICAL TREATMENT DECISIONS
If I am unable to make or communicate my own decisions, and have a terminal illness, irreversible condition with no reasonable prospect of recovery, or am permanently unconscious:
I DO CONSENT to the following treatments:
• [List treatments you would accept]
I DO NOT CONSENT to the following treatments:
• [List treatments you would refuse]
Specific Situations:
• If I have a severe, irreversible brain injury with no reasonable prospect of recovery, I [do/do not] want the following treatments: [List specific treatments]
• If I have end-stage dementia and cannot recognize my loved ones, I [do/do not] want the following treatments: [List specific treatments]
5. VALUES AND BELIEFS STATEMENT
The following values and beliefs should guide decisions about my care:
• [Religious or spiritual beliefs relevant to medical care]
• [Cultural considerations]
• [Quality of life factors important to you]
• [What gives your life meaning]
For me, an acceptable quality of life includes:
• [Describe circumstances you would find acceptable]
I would find the following circumstances unacceptable:
• [Describe circumstances you would find worse than death]
6. ADDITIONAL REQUESTS
• Preferred place of care: [Home/Hospital/Hospice/Other]
• People I would like present: [Names]
• Other requests: [Any additional preferences]
• Organ donation wishes: [Your preferences]
7. SIGNATURES
Person Making Directive:
Signature: ___________________ Date: ______________
Witness 1:
Name: ______________________
Signature: ___________________ Date: ______________
Witness 2 (if required by your state):
Name: ______________________
Signature: ___________________ Date: ______________
Medical Practitioner (if required by your state):
Name: ______________________
Registration Number: __________
Signature: ___________________ Date: ______________
Keeping Your Directive Current and Valid
An outdated Advance Care Directive may not accurately reflect your current wishes or may be questioned by healthcare providers. Establish a regular review process:
When to Review Your Directive
The Royal Australian College of General Practitioners recommends reviewing your directive:
Annually, even if no changes are needed
After any significant health diagnosis
Before major surgery or medical procedures
If your values or treatment preferences change
When family circumstances change significantly
If you relocate to a different state or territory
After changes in relevant legislation
How to Update Your Directive
When changes are needed:
Complete a new directive rather than altering the existing one
Follow your state's formal requirements for the new document
Clearly date the new directive
Write "revokes previous directive dated [date]" on the new document
Destroy or clearly mark previous versions as superseded
Update all locations where your directive is stored
Inform all relevant people about the update
Communicating About Your Directive
Regular communication supports the effectiveness of your directive:
Schedule annual conversations with your substitute decision-maker
Discuss your directive during routine medical appointments
Inform new healthcare providers about your directive
Update family members about any changes to your wishes
Consider recording a video explaining your values and reasoning
Common Challenges and Solutions
Even well-prepared Advance Care Directives can face implementation challenges. Understanding common issues helps you develop more effective documents.
Vague or Contradictory Instructions
Challenge: Directives with unclear statements like "no heroic measures" or contradictory wishes create confusion.
Solution:
Use specific, concrete language about treatments
Explain your understanding of medical terms you use
Provide context through your values statement
Have a healthcare professional review for clarity
Consider discussing specific scenarios with your doctor
Interstate Recognition Issues
Challenge: Moving between states can create uncertainty about directive validity.
Solution:
Update your directive when moving interstate
Use the new state's official forms
Include your previous directive as an attachment
Ensure your substitute decision-maker understands interstate issues
Register with new state systems when available
Disagreement Among Family Members
Challenge: Family members may disagree about interpreting your wishes or may challenge your directive.
Solution:
Discuss your directive with family members in advance
Clearly document your decision-making capacity
Consider having your GP confirm your capacity
Explain your reasoning for key decisions
Appoint a decisive substitute decision-maker you trust
Emergency Situation Access
Challenge: In emergencies, healthcare providers may not know about or have access to your directive.
Solution:
Wear a medical alert bracelet mentioning your ACD
Carry a wallet card with directive information
Ensure your My Health Record is updated
Register with state systems where available
Tell ambulance services in advance if you have chronic conditions
The Australian Commission on Safety and Quality in Health Care provides additional strategies for addressing these common challenges.
Next Steps: Creating Your Advance Care Directive
Follow this step-by-step process to create your Advance Care Directive:
Research your state's requirements using the links provided in this guide to ensure compliance with local regulations.
Reflect on your values and preferences regarding medical treatment, quality of life, and end-of-life care. Consider what matters most to you.
Discuss your thoughts with family members, close friends, and healthcare providers to refine your understanding and preferences.
Choose your substitute decision-maker(s) carefully and have detailed conversations about your wishes.
Complete the appropriate forms for your state or territory, ensuring all required sections are addressed.
Arrange for proper witnessing according to your state's requirements.
Distribute copies to relevant people and organizations, including your GP, specialists, hospital, substitute decision-maker, and close family.
Register your directive with appropriate systems, including My Health Record and state registries where available.
Schedule regular reviews to keep your directive current and relevant to your circumstances.
By creating a comprehensive, clearly written Advance Care Directive that follows your state's requirements, you provide invaluable guidance to those who may need to make decisions on your behalf. This document serves as your voice when you cannot speak for yourself, ensuring that your care aligns with your values and preferences even in challenging circumstances.
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