FAQs

Advance Care Planning helps you think about and share your thoughts and wishes about your future health care.

Advance Care Planning gives you a voice and choice in future decision making if you are unable to communicate your own wishes about your future healthcare.

An Advance Care Plan is simply the document that records your wishes for future health care. Advance Care Plans are used should there come a time when you are unable to voice your wishes.

In the ACT an Advance Care Plan can be implemented in three ways. (you are not limited to one)
Each process can be attended individually or in complement with the other.
These processes are:

Enduring Power of Attorney (EPA) Appointing an EPA is a legal document where a person appoints a substitute decision-maker, known as a 'attorney' in the ACT. The person must have 'legal capacity' to complete this document.

Advance Care Plan Statement of Choices a guidance document that covers a person’s wishes and choices around health care.

Health Direction (optional) a witnessed legal document that gives competent adults the legal right to refuse or withhold medical treatment.

All describe methods and forms where an individual plans ahead for health care related decisions in the event they do not have the ability to make decisions or communicate for themselves.

These documents may be very important if you do not have anyone to appoint as a substitute decision maker or if your substitute decision maker is not aware of your wishes.

An Advance Care Directive is an official term for the documentation of an Advance Care Planning activity. Australian States and Territories have different legislation, forms and processes.

The website advancecareplanning.org.au clearly outlines the requirements of each State and Territory.

Everyone under 18 who has the capacity to make their own medical decisions can do an Advance Care Plan.

Medical technology offers many complex lifesaving treatments. In each individual circumstance the type and implications of treatment offered are carefully explained by the health care team and consider both the disease process and the wishes of the patient. A person may be in a situation where a sudden event, such as stroke or accident ,or a slow decline such as dementia, sees them unable to make healthcare decisions for themselves. Through an Advance Care Plan someone can “be their voice” and make choices about health care treatments on their behalf.

They can only be used if you are unable to make or communicate your own decisions.

To have capacity means that you understand the implications of the decisions you make regarding your health care treatment. If you have capacity you:

• Understand the facts involved

• Understand the choices

• Are able to weigh up the consequences of the choices

• Understand how the consequences affect you

• Can communicate your decisions

If there is doubt about capacity a Doctor is required to confirm this.

Where a person does not have capacity, such as individuals with severe acquired brain injury, advanced dementia or people born with an intellectual disability, health care professionals look to a substitute decision maker to make decisions on their behalf.

If the person has previously appointed a person to act as their attorney or substitute decision maker, then that attorney can complete an Advance Care Plan on their behalf. This is known as an Advance Care Plan Statement of Choices -no Legal Capacity . It is important to include the person, to the best of their ability, in the discussions prior to completing the forms. The form designed for this process has detailed information attached. This form is also completed by a Medical Practitioner

If the person has no substitute decision maker and medical consent is required for a person with impaired decision-making ability, a health attorney can be appointed by the senior treating doctor at the time the substitute medical consent is required.

In situations where ongoing decision making ability is lost and there is no Enduring Power of Attorney in place, the only course is for the appointment of a guardian and/or manager by the ACT Civil & Administrative Tribunal. The process for the appointment of a family member or friend takes 6 to 8 weeks.

No. It is important to emphasise that Advance Care Planning does not support or facilitate euthanasia, which is the deliberate taking of life. Euthanasia is against the law in Australia. Many individuals find that by completing and documenting their Advance Care Plan they have some control over what will happen to them in the future.

No capacity to include Voluntary Assisted Dying (VAD) Voluntary assisted dying laws in the ACT - Justice and Community Safety Directorate in Advance Care Plan Statement of Choices at the moment.

Yes. An Advance Care Plan is about end of life health care, a will is about choices you have made and want implemented after your death.

If there is no plan in place or no one to “be your voice” your treating health care team will help your family make the decisions required.This may include appointing a family member to be a health attorney to make immediate decisions. However, if there is an ongoing lack of capacity, and  long term requirement for a substitute decsion maker, a permanent  guardian must be appointed by the ACT Civil and Guardianship Tribunal.  

Planning ahead helps you to think about your current health, the things that make your life worthwhile and the type of future health care you would choose if you become seriously ill. Planning ahead gives you time to talk with your family and help them to understand that there may be a time when they may need to make decisions for you. It also means that if you do become seriously ill your family, or someone appointed by you, will have something in writing for doctors to ensure your wishes are followed.

While health professionals always carefully involve the next of kin in health care decisions you should be aware that in the ACT your next of kin has no automatic legal entitlement to make decisions on your behalf, if you are unable to do so yourself, unless you have appointed an attorney under an Enduring Power of Attorney(EPA).

More information about this process can be found in the "Power to Choose" booklet provided by the office of The Public Advocate of the ACT.  In an emergency situation if there is no EPA in place the treating medical team can appoint an attorney to make medical decisions. However, if the situation is long term and ongoing lack of capacity is identified, a more permanent measure of advocacy for the person is required.The ACT Civil and Administrative Tribunal will be requested to appoint an appropriate guardian.

None of us know what the future holds and trying to think about your future treatment wishes may be difficult. However most of us have had life experiences and possess values and beliefs that would shape our choices if we were unable to make health care decisions in the future. Planning now will help your family and friends know they are acting as you would have wanted.

To start making the plan you need to:

• Think about what gives your life meaning, what you value in terms of lifestyle and what it means to you to live healthy and well.
• Understand your current health status and possible medical treatments and options for health conditions that may arise.
• Talk to the person/s that you would want to make health and lifestyle decisions for you.
• Consider legally appointing an Enduring Power of Attorney and document your wishes accordingly.

Applicability in other states and territories

In general, a valid ACT Health Direction will apply in other states and territories in Australia, although there may be some limitations and additional requirements. It may be recognised under common law.

Similarly, an appointment of an attorney will usually apply, but there is variation in the laws within Australia. It is recommended that a person obtain specific advice from the Office of the Public Advocate or equivalent in the relevant state or territory.

If a person is permanently moving state or territory, it is recommended that they update their documentation using the recommended form(s).

Advance care directives from other states and territories

There are currently no provisions in the ACT for the recognition of advance care directives made in other Australian jurisdictions. However, these documents may be valid under common law. 

A valid interstate appointment of a substitute decision-maker(s) is recognised in the ACT as an attorney. 

The person(s) you nominate in your Enduring Power of Attorney is called your attorney. They should be someone who you trust, who is 18 years of age or over, who will listen carefully to your values and wishes for future care, and someone who will be comfortable making decisions that may occur in difficult situations. Usually the nominated attorney is a family member, but it can be anyone you trust.

No. In the ACT the forms have been developed by the Public Trustee and Guardian so that people can complete an EPA without the necessity for a lawyer. You may elect to have this process attended by a lawyer if you wish.

Enduring power of Attorney form - Public Trustee and Guardian

Talk to your family and to those most likely to be involved in making decisions should you become unable to make decisions for yourself. Do not assume that family members already know or understand your wishes for future medical care.

Talk to your doctor. They will help you understand your health condition and treatment options and assist you to make sure your Advance Care Plan is clear and complete.

Talk to an Advance Care Planning consultant who will help you to discuss these issues with your family and doctor.

The ACT Health Advance Care Planning Program office (previously known as Respecting Patient Choices) can be contacted on 5124 9274 email [email protected].

These conversations can be difficult, here are some helpful suggestions:

• Acknowledge that what you are talking about may make them feel uncomfortable or sad but it is important to you and you really need them to hear what you have to say.

• Explain that you are planning ahead in case you are either seriously ill or injured and/or dying and may not be able to communicate for yourself what medical care you would want. This will help answer comments they may make like ‘You’ve got plenty of time/life left in you or ...why do you need to talk about this now.....?

• Let them know that you want them to know your choices and wishes so if you cannot speak for yourself they will not feel stressed by trying to guess what you would want or burdened by having to make a decision on your behalf and not know what decision you would have made yourself.

• Describe what makes life meaningful to you and what is/would be unbearable. You can use your contemplation of your values as well as your reflections on past health experiences and/or current health status to help with this.

Yes, As life circumstances and health may change throughout your life it is good idea to review and rewrite your Advance Care Plan to reflect any changes you need to make.

Make sure you have discussed these changes with your appointed attorneys, family and important others in your life. Also destroy any old copies and be sure to share and send your new Advance Care Plan to the people and facilities on your share copies list (Page 1 of the Statement of the Statement of Choices document.)

If you wish to revoke your Enduring Power of Attorney please refer to the ‘Power to Choose document from the Public Trustee and Guardian and visit the website at https://www.ptg.act.gov.au/

When the time comes, your Advance Care Plan choices and decisions will be respected. Sometimes, however, it may not be possible to follow a person’s directions because of a range of complicated factors. Having your close family understand your wishes for end of life care is important. 

The best way to ensure you receive the type of care you want is to discuss your choices with your substitute decision-maker(s) and make sure they have a copy of your Advance Care Planning documents. A card in your purse or wallet with your important contacts will help if anything happens when you are away from home. You may also consider keeping your documents with you when travelling, particularly if you are in failing health. Most States and Territories in Australia will recognise a valid Advance Care Plan. Some people consider an medi- alert bracelet indicating a plan is in place.

My Health Record (national access) is a secure online summary of your health information. You control what goes into it, and who is allowed to access it. Your record allows you and your doctors, hospitals and other healthcare providers to view and share your health information to provide you with the best possible care. By adding your Advance Care Plan to your record you can be assured that your wishes for end-of-life care are respected when you can no longer speak for yourself. You can add your document to the National My Health Record and it will be accessible Australia wide. 

Add an advance care plan here, My DHR Digital Health Record (DHR) | Health (act.gov.au) - Canberra Health Service, North Canberra Hospital, Clare Holland House, Walk-in Centres and Community Health has access to it. 

In an emergency, your medical records may not be available at short notice and life-sustaining measures may be started. Following discussions with your substitute decision-maker(s), treatment can be stopped if it is clear that the treatment is not what you would have wanted and is providing no benefit to you.

In some urgent situations, it may not be possible to locate a substitute decision-maker. If a decision is needed in an acute emergency, best medical practice will guide whether life- sustaining measures are commenced.