Advance care plans

Advance care planning helps the people close to you know what is important to you about the level of healthcare and quality of life you would want if, for some reason, you are unable to participate in the discussions.

Discussing and writing down your wishes for future care will help the person you choose as your medical treatment decision maker to feel more comfortable about the decisions they make on your behalf.

A guide to advance care planning

It is recommended that you take several steps to make sure your wishes are known in case you become sick and unable to make your own decisions. These include:

• Think about your wishes for future care.
• Have the conversation.
• Consider appointing someone to be your medical treatment decision maker.
• Write your wishes down in an advance care directive.
• Give your advance care directive to others.
• Review it regularly or when your situation changes.

Take Control – a guide to advance care planning

Take Control is a free guide you can download from the Office of the Public Advocate website.

It includes the information and forms you need to appoint a medical treatment decision maker, complete an advance care directive or make an enduring power of attorney.

Think about your wishes for future care

There are certain things for you to consider regarding your medical treatment and the care you would want. Think about what might happen if you couldn’t make decisions regarding your care for some reason. Do you have views or preferences about your care that you would want known?

Out of the people in your life who are close to you and know you well, consider who you would trust to be able to make decisions for you about the type of healthcare you receive, and your quality of life. Think about what you would like them to consider if they had to make decisions on your behalf.

Read these personal stories of advance care planning.

Talk about what kind of care you would want

To make sure the things that are important to you are known if you get sick and decisions need to be made for you:

• Talk to those close to you.
• Talk to your family.
• Talk to your doctor and treating team.

Some useful questions to consider and discuss are:

• If you have a condition, what do you know about it?
• What are your goals in life? What is important to you?
• What are your fears about what is to come?
• What would you like to do as time runs short?
• How important is it to you to have more time?
• Think about:
  • managing pain and suffering
  • longevity
  • dignity
  • independence.

How important are these considerations to you, and which is the most important? If it is not possible to achieve all of these, what trade-offs are you willing to make?

These are emotive questions that can be difficult to discuss. If you’re looking for somewhere to start, the MyValues web-tool can help you identify, consider and create statements that communicate your wishes about medical treatment.

Consider appointing someone to make decisions for you

A medical treatment decision maker can make medical decisions on your behalf if you are unable to participate in decision making.

Consider choosing someone who:

• is close to you
• has a clear understanding of your wishes, and whom you trust to follow those wishes and act in your best interests
• can be a strong advocate for you
• is 18 years of age or over
• is willing to take on the role
• is not your paid carer
• is not a healthcare practitioner who is responsible for your health care.

You will need to complete a form to appoint your medical treatment decision maker and sign it in front of two witnesses. One of these witnesses must be authorised to witness an affidavit. Your medical treatment decision maker cannot be one of the witnesses.

Find more information about medical treatment decision makers.

Download a form to appoint your medical treatment decision maker.

Write your wishes in an advance care directive

In an advance care directive, you can document your wishes for future medical care. Advance care directives are legally recognised documents that must be considered by health practitioners and your medical treatment decision maker.

An advance care directive can include two different types of statements: a values directive, and/or an instructional directive.

In a values directive, you can record general statements about your priorities and preferences for medical treatment to help guide your future health care. You should include anything that’s important to you or that you’re worried about. It’s a good idea to think about:

• your beliefs and values
• what you would and wouldn’t like
• where you would like to be cared for at the end of your life.

A values directive may contain statements such as:

"If I am unable to recognise my family and friends and cannot communicate, I do not want any medical treatment to prolong my life."

"If I am dying, I would like to be in a comfortable environment surrounded by my friends and family.”

Some people may also wish to refuse, or consent to a specific medical treatment in their advance care directive. You can do so by completing an instructional directive and specifying under what circumstances you would want, or would not want certain medical treatments. You do not have to complete an instructional directive when making your advance care directive.

An instructional directive may include:

• A statement that a person consents to a heart bypass operation in specified circumstances.
• A statement that a person refuses cardiopulmonary resuscitation (CPR) in any circumstance.

You should talk to your doctor and treating team to assist you to write down your wishes. This will give your doctor and your medical treatment decision maker greater certainty that they are making the right decision for you, if you are too unwell to make the decision yourself.

There is no prescribed form in Victoria for making an advance care directive. It can be a letter you write, or a form given to you by your general practitioner. One option is to use this advance care directive made by the Victorian Department of Health.

If you do not wish to use the above form, ensure that any advance care directive you make complies with the formal requirements set out in the Medical Treatment Planning and Decisions Act 2016.

Even if you do not make a formal advance care directive, anything you document about your wishes for future care will still provide useful information for your medical treatment decision maker .

Give your advance care directive to others

Keep the original copy of your advance care directive and medical treatment decision maker appointment form in a safe place. Then, to make sure they are found and actioned, give a copy to:

• your medical treatment decision maker
• your family
• your doctor
• the hospital you most regularly use – ask for an alert to be put in your medical record.

Sign up to the Australian Government's personally controlled MyHealth record where you can upload all your advance care planning documents to make it easier for others to find them

Reviewing your advance care directive

You can review and change your advance care directive at any time. You may be prompted to review your directive when your circumstances change. For example, if:

• you have been hospitalised for a severe or ongoing illness
• there has been a change to your condition or your health has become unstable
• you decide you want to refuse life-sustaining treatment
• you or your family are enquiring about palliative care.

If you decide to make any changes to your advance care directive, you should discuss this with your medical treatment decision maker, your family, your doctor and other relevant healthcare professionals. Give an updated copy of any documents to all those who were given the first copy so they are aware of the changes.

Where to get help

• Speak to your GP
• The Office of the Public Advocate
• Palliative Care Advice Service