Advance Care Planning – Starting a Conversation

Advance Care Planning – Starting a Conversation

What is Advance Care Planning?

Advance care planning (ACP) ‘is a process of planning for future health and personal care whereby [your] values, beliefs and preferences are made known so they can guide decision-making at a future time when [you] cannot make or communicate [your] decisions.’ (1)

ACP is not just for older people. It is for all people who wish to promote their choices and control their future health care and personal care once they are deemed incapacitated. ACP can also help to reduce the stress and anxiety your family might otherwise experience when it comes time to make decisions about those matters. With effective ACP, your family members are more likely to be satisfied with your care.

What does an advance care plan look like?

In the ACT the components of an advance care plan include:

  1. an Enduring Power of Attorney (EPoA);
  2. a Statement of Choices; and
  3. Health Direction.

An EPoA and Health Direction are both legal documents which contain directions about the refusal or withdrawal of medical treatment. Neither document can provide directions for the administration of medical treatment or illegal activities such as euthanasia or assisted suicide (however, it is possible to include a wish for a certain end-of-life procedure in the event the illegal activity is later decriminalised). If the direction in a Health Direction is inconsistent with a direction in an EPoA, then the treating medical practitioner must comply with the Health Direction. The practitioner is obliged to comply with a current and valid direction, that is, the onus is on them to check that the EPoA or Health Direction is valid and that the document has not been revoked by a later document (that might revoke or alter the earlier direction).

You should note that the components of the advance care plan mentioned above are specific to the ACT. There is no national scheme covering advance care plans, which means each State and Territory has different documents with different names. It is recommended that if you move interstate you review your advance care planning to make sure it is fully recognised in your new place of domicile.

Who is responsible for making decisions on my behalf?

An EPoA is a legal document in which you appoint a substitute decision-maker (SDM) to make decisions on your behalf. A 2018 study (2) found that the biggest considerations for people when they are trying to decide who to appoint as their SDM are:

  1. who is someone they trust;
  2. who will cope best; and
  3. who knows their preferences.

The study found that the biggest concern for people is that their SDM will not be able to cope, hence why it is so important to have the conversation about ACP before it is too late. Starting a conversation about ACP is difficult. Whether it be a conversation with your family, or your health practitioners, ACP is something that you should be talking about more. Often the conversation can be incidental to other topics such as talking about your life values, your ‘bucket list’ items, your past experiences and so on.

In most cases, if a person does not have an advance care plan (either an EPoA or Health Direction) then treating medical practitioners will make treatment decisions based on their assessment of the person and that person’s best interests. In some cases this can be contrary to a person’s wishes or the decisions that they would otherwise had made if they were able to do so.

Start the conversation now

Ultimately, the aim of ACP is ensuring that you receive care and medical treatment that is consistent with your preferences. It is also important to ensure that SDMs are provided with the knowledge, awareness and confidence so that they are prepared and supported for when the time comes to make those difficult and sometime heartbreaking decisions about your personal and health care matters.

What should you do?

Talk to your family and friends and start a conversation about ACP today.

For information, contact the Wills and Estates Team:

Tanya Herbertson, Partner

Tanya.Herbertson@MVLawyers.com.au

 

1 Fountain S, Nolte L, Willis M, et al. 2018. Review of advance care planning laws across Australia: short report. Austin Health, Melbourne: Advance Care Planning Australia.
2 Detering, K, Tran J, Nolte, L, et al. 2020. The Australian public’s knowledge, attitude and experiences regarding substitute decision making for medical decisions: A national cross-sectional survey study. Advance Care Planning Australian, Austin Health, Melbourne.