Taking Control of Your Health Decisions: Advance Care Directive & Enduring Guardian (NSW)

Life is full of unpredictability. While it may be uncomfortable to think about scenarios like accidents, serious illness, or the late stages of dementia, being prepared can make all the difference for you and your loved ones. 

What is an Advance Care Directive (ACD)? 

An Advance Care Directive (ACD) is a written, legal document that outlines your preferences for medical treatment and care if you become terminally ill or are incapacitated due to serious injury or other health conditions. It serves as a guide for healthcare professionals and caregivers, giving you control over the type of medical care you receive, and relieving your loved ones from the burden of making difficult decisions during moments of crisis or grief. 

By clearly stating your wishes in advance, you reduce confusion and minimize the potential for disagreement among those making decisions on your behalf. 

Why is it Important to Make an Advance Care Directive? 

Creating an Advance Care Directive is a crucial part of advance care planning. Through an ACD, you can formally express your healthcare preferences in writing, covering: 

• Your ideals and aspirations for future care. 

• Desired outcomes and specific instructions for medical treatment. 

• The appointment of a formal substitute decision-maker. 

This directive helps ensure that your medical care aligns with your values and wishes even when you can no longer express them yourself. 

Who Can Make an Advance Care Directive? 

Any adult with the capacity to make decisions can create an Advance Care Directive. There is a common misconception that only older individuals or those in poor health need one, but the reality is that life and health are unpredictable. This makes it beneficial to have your ACD prepared early. 

When valid, your ACD must be followed by healthcare professionals and your family, and they are not permitted to override your stated wishes. 

Note: Decision-making capacity refers to your ability to make decisions about various aspects of your life, including legal, financial, medical/healthcare, and personal matters. 

How to Select a Substitute Decision Maker 

Appointing a substitute decision maker is a significant decision that requires careful consideration. Ask yourself questions such as, “Will this person respect my wishes?” or “Is this person capable of handling the responsibilities involved?” 

Here are some key requirements for a substitute decision maker: 

• Must be someone you trust. 

• Must be over 18 years of age. 

• Must be someone who will respect your values and future care preferences. 

• Must be capable of making difficult decisions under challenging circumstances. 

In different parts of Australia, substitute decision makers are referred to by various names. In New South Wales, they are known as “Enduring Guardians” under the Guardianship Act 1987. 

When Does Your Advance Care Directive Apply? 

Your Advance Care Directive will be used by medical professionals when you are unable to make or communicate decisions about your healthcare and treatment. It guides the person responsible for your care and must be referred to before any medical or health decisions are made on your behalf. 

Doctors will also assess whether your ACD is valid before acting on any treatment or care instructions it contains. 

Sharing Your Advance Care Directive 

To ensure your ACD is respected and easily accessible, provide copies to: 

• Your family. 

• Your Enduring Guardian. 

• Your hospital and doctor. 

• The ambulance services. 

• Anyone else you deem appropriate. 

By taking these steps, you empower yourself to have the final say on your healthcare decisions and offer peace of mind to those who may need to act on your behalf.