Updating Advance Care Directives

In the Movie Just like Heaven a young doctor Elizabeth Masterson, played by Reese Witherspoon, is in a serious car accident. She is in a coma, on life support at the hospital where she used to work. Her sister Abby is informed that Elizabeth has made an Advance Care Directive (“ACD”) that states if she is in an extended coma life support should be terminated.

While you have capacity you are the only person who can make decisions about your health. Your consent is required before undertaking any treatment.

If you are unable to consent to treatment for example you are unconscious or lack capacity, your doctor must obtain consent from your ‘person responsible’; This will be your enduring guardian if you have appointed one, otherwise, your person responsible will be, (in order), your partner, a person caring for you, a relative or close friend.

 We can’t be sure of the future so it’s a good idea to discuss your future health care wishes with your family and friends or your enduring guardian. If you don’t do this if the time comes that they need to make decisions for you, they may not know what you would have wanted.

In some cases people write an ACD  or “living will”as a written record of their wishes or instructions about the treatment they want or don’t want in situations when they are unable to make decisions about your medical treatment.

The NSW Health Department’s guidelines to doctors make it clear that if an advance care directive meets the following principles doctors are legally bound to follow it.

•  It needs to be clear and specific regarding the treatments that you would accept or refuse;
• It needs to be current – it is important to review your ACD regularly or if there is a big change in your health.
• You must have capacity to understand the choices you are making in your ACD.
• It is also a good idea to have it witnessed.

Sometimes people make ACD’s as part of appointing an enduring guardian. It should be remembered that an ACD cannot be used to demand treatment that your doctors think would be futile, or is illegal.

An Enduring Guardian is appointed as a your ‘substitute decision maker” and can only make medical, health and lifestyle decisions on your behalf. In most jurisdictions you appoint the Enduring Guardian on a form which allows you to delete or add the functions you  want your Enduring Guardian to have.

Your Enduring Guardian cannot consent to medical or dental treatment on your behalf when you object to that treatment.

An ACD should be updated regularly. Your circumstances may change; therefore the ACD should continue to accurately reflect your situation and wishes. It has been suggested that you should re-examine your wishes whenever any of these “Five D’s” occur: Each new Decade of your life, the death of a loved one, divorce or other major family change, when you are diagnosed with a serious health condition or experience a significant decline or deterioration of an existing health condition.