An “Advance Care Directive” (also referred to as a Living Will) is a document stating the specific medical treatment you do or do not wish to receive. In order to make an Advance Care Directive you must
- have legal capacity, and
- the document must set out the medical treatment that you want to receive in a clear and unambiguous way
Advance Care Directives enable you to set out the medical care you wish to receive when medical technology might be required to keep you alive.
Importantly as you may lack the capacity to make decisions about your medical treatment the person or persons you appoint as substitute decision-makers, family members and significant others must be informed of your medical wishes.
All jurisdictions in Australia have enacted legislation enabling a person to register a refusal to accept medical treatment or appoint another person to carry out their wishes.
Illness affects people in different ways it can cause pain, discomfort, distress and disability. Illness sometimes stops you from enjoying a normal life.
Think about your life goals and the things that are most important to you. What is important to you – spending time at home with your family; traveling; ideally what hobbies would you like to be engaged in most days?
If you were to fall ill what outcomes would you expect from medical treatment and would you prefer to be cared for at home or in a medical facility such as a hospital or nursing home?
If you were diagnosed with a terminal illness would you ask for life-prolonging treatments in any circumstances – or are there circumstances when you would not want them?
Have you been close to a family member or friend who has died? Do you think their death was a ‘good’ death? Why?
The idea of a “good death” is about choices including having family or close friends around them; whether they want to die at home, if that is possible.
Are there things about your friend or family member’s death you think could have been done better?
If you were terminally ill what would you and your friends and family want?
You may have received medical treatments or you have seen others experience treatment that influences your views?
Do you have questions regarding past treatments that you wish to ask your doctor?
Before you can make informed decisions about your medical care, it’s important that you understand your views and attitudes about illness, medical treatments and to learn about the care options that you have and decide how you would want to be cared for.
Ultimately you should be open about the effects of any treatment you might have so depending upon your illness what treatments and what care would you want?
If you become seriously ill or injured, you may be unable to make decisions for yourself. However if your family, friends, carers, and doctors know your preferences they can act in your interests.
Importantly talk with your family, friends, carers and health professionals about the level of care you would like if you were sick or unable to care for yourself. Tell them your values, goals, and what level of care you would or would not want and under what circumstances.
Sometimes an illness can lead to an inability to make your own decisions, in order that your wishes are complied with you can appoint a person you trust to make treatment and care decisions on your behalf.
When picking this person, they should be:
- someone you trust
- someone who understands your values and preferences for care (do you want them to follow your preferences exactly as you have written and discussed them? Or would you prefer them to take your preferences into account but to also use their own judgement in coming to a decision?)
- prepared to advocate on your behalf with your doctors, other health professionals, care workers and family members.
- live close to you (ideally in the same city or region)
- over the age of 18
Importantly complete your advance care directive in writing and involve your decision maker and medical staff as this helps them to be aware of your preferences about the sort of care you want, as medical staff might have to make an urgent decision, your substitute decision-maker might need confirmation about your wishes when they need to make decisions about your treatment, or both.
In the absence of an advance care directive consent for medical treatment must be considered on a case by case basis and may be given by:
- the patient if they have legal capacity;
- the patient’s guardian;
- the spouse of the patient (if they have capacity),
- by the patient’s carer;
- or by a close friend or relative of the patient.
An Advance care directive is an important part of planning for your future and should be discussed with your loved ones at the time it is prepared.