Advanced Care Planning is something we all know we should do, but so often it’s left to the bottom of the pile.

For our Canberra Region community, it’s also important to be aware of the differences between Advanced Care Planning in the ACT and NSW. So let’s get into it!

What is Advanced Care Planning?

There are a lot of terms, processes and concepts that can all get mixed up in this space. Advanced Care Directives, Living Will, Last Will and Testament, Enduring Power of Attorney, Enduring Guardian, Statement of Choices, Health Direction – it can be confusing. So let’s clear up what’s what.

Advanced Care Planning is the process for recording your choices and preferences for your health care if you’re unable to communicate those yourself. It doesn’t cover financial matters, property matters or any other legal responsibility; just how you’re looked after medically. Good Advanced Care Planning will help you consider questions like:

  • What kind of care would you like, or choose to refuse?
  • What outcomes are acceptable to you as a result of medical care?
  • Who would you like to make decisions for you if you can’t make them for yourself?
  • Where would you like to be cared for if you were dying?

Importantly, Advanced Care Planning is not just about dying; it’s also about how you would like to live. Medical decisions aren’t just about if you live or die; they may be about whether you die, or recover fully, or make a partial recovery and require a level of medical or personal support either temporarily or from that moment on.

Several different documents may be part of your Advanced Care Plan.

In the ACT:

All of the forms below are available at ACT Health’s Advance Care Planning web page under the heading ‘What documents do I need?’, along with more details and extra information beyond this article here today.

Statement of Choices

The Statement of Choices captures all the decisions and supporting paperwork you’ve put in place for your Advanced Care Plan. It gives your space to outline what you define as an acceptable quality of life, what you understand your current health situation to be, your choices for life-prolonging treatment and more. It records your health professionals, your Substitute Decision Makers and whether you have an Enduring Power of Attorney. It’s clear, simple and well explained, both for you, as the person filling it out, and for the family and health professionals who need to read it.

Health Direction

The Health Direction is a legal document that only deals with medical treatment you may choose to refuse or require the withdrawal of

Enduring Power of Attorney

The Enduring Power of Attorney is a legal document that identifies who may make decisions on your behalf if you’re unable to at the time the decisions need to be made, either because of temporary or permanent incapacity. This person is known as your ‘attorney’ or ‘substitute decision maker’. In the ACT, there are a number of powers that all come under the same form; financial and property decisions, health and personal care, and medical research. You can choose which powers your attorney(s) have and you can also nominate a substitute attorney, should your primary one be unavailable. For example, many people would nominate their spouse as primary attorney, then one or more of their children, or a close friend, as their back-up option.

In NSW:

In NSW, there is no formal form like there is in the ACT. You can handwrite it or type it, as long as:

• you have capacity to make your own decisions when you write it
• it is clear and specific about medical treatments that you do and don’t want
• it reflects your preferences and nobody else’s
• it applies to the situation you are in at the time.

You don’t even have to sign it, although it’s good practice to have your signature and ideally the signature of a witness or a healthcare professional just to help other medical professionals have confidence that it’s valid. There is more information available in NSW Health’s booklet ‘Making an Advanced Care Directive’.

In NSW, instead of an Enduring Power of Attorney (which covers many powers, including health care), if you want to assign somebody to be your substitute decision maker you need to appoint an Enduring Guardian. This role is only for matters of health and lifestyle.

What if I live in NSW but get my medical care in the ACT?

If you’re expecting to have most of your healthcare done in the ACT, the ACT Advanced Care Planning team is still able to help you out. And documents created in each jurisdiction should be recognised in the other. However, it’s worth remembering that medical staff in, say, Goulburn, will be used to the NSW system and staff at the Canberra Hospital will be used to the ACT process. So if you’ve created your documents in one jurisdiction, but are expecting to need them more in another, it’s worth updating them to reflect your current need.

What about my will? Or a living will?

Living will is a term that is more often used in the US and other countries for a similar process to Advanced Care Planning, but it’s not used in the ACT or NSW. Your Last Will and Testament only comes into effect once you’ve actually died; it has no legal implications for your care while you’re still alive. So any directions for your care while you’re still alive need to happen through the processes and documents mentioned above.

Who should do Advanced Care Planning?

Everyone over the age of eighteen with decision-making capacity! It might feel too far off for a younger person to worry about, but sudden accidents or unexpected illness can happen to anyone. It’s an enormous help to your family if they’re being asked to make life-altering or life and death decisions for you. For example would you want to be resuscitated if the likely best-case outcome was Scenario A, but not if it was Scenario B? If your family knows what you want, you’re more likely to get that outcome.

How often do I need to refresh my Advanced Care Planning?

Once it’s done, many people breathe a big sigh of relief. But that doesn’t mean it should be over. Life can change, and the medical and care decisions you make when you’re fifty might look very different from when you’re eighty. You should consider whether any of your advanced care planning might need to change if:

  • Your base level of health changes, either for the better or the worse
  • Your personal situation (e.g. work, home arrangements, family support) changes
  • Your substitute decision maker is no longer available (e.g. they move to another city)

Who can help me do my Advanced Care Planning?

The ACT is the only jurisdiction that has an Advanced Care Planning team as part of their health department.  Tender Funerals Canberra Region is part of the network they’ve set up for organisations who work in this space to collaborate and share what they’re doing. They are so lovely and friendly that you can actually call them directly (02 5124 9274), or email them ([email protected]), and they will take you through the whole process. You can even go in and sit down with them. It’s a great service.

In NSW, your local council or health service may have recommendations for support in your area. Otherwise, the National Advanced Care Planning Support Service can be contacted on 1300 208 582 for more information and advice, 9am – 5pm, Monday – Friday (AEST) or you can email them on [email protected]

Key takeaways