Doctors, Aged Care & Financial Planners

An Advance Care Plan is a document that sets out any medical treatment you do or do not consent to – in advance, to be relied on only in the event you lose decision-making capacity.

An Advance Care Plan can also set out your values. That is, those things that are important to you (and which may influence your choices) – such as being able to communicate with your loved ones. Setting out your values can help inform your doctors, carers and substitute decision-makers about what treatment you would or would not have consented to.

If one day you lose decision-making capacity, an Advance Care Plan can assist those involved with your care to make treatment decisions on your behalf by informing them of your wishes. It is therefore important you share your Advance Care Plan with others so it is readily available in the event you lose capacity (which can happen suddenly and unexpectedly, such as in the case of a head injury).

Your Advance Care Plan can inform your family and doctors what specific treatments you do and do not want. It can also inform them what your values are, so they can be guided in deciding what treatment you would or would not have wanted (if such treatment is not specified in your Advance Care Plan). An Advance Care Plan will assist your family or doctors in making decisions about your medical treatment that are in line with your preferences in the event you cannot speak for yourself.

An ‘Advance Care Plan’ is separate and distinct from a document prepared by health practitioners to plan your care, which is often referred to as a ‘Care Plan’. An Advance Care Plan is not to be confused with a Care Plan (which should include an Advance Care Plan).

While a Care Plan should be prepared taking your preferences into account (particularly if you are in aged care), it is not an Advance Care Plan. An Advance Care Plan can only be completed by you, and sets out your choices only. It does not include an assessment of your needs, which a Care Plan does. While an Advance Care Plan may be completed with support from health practitioners, it cannot be completed by them.

Yes.

A Touchstone Life Care Advance Care Plan is:

• Legally valid as a Common Law Advance Care Directive.
• A legally valid expression of your wishes.
• Must be considered by health professionals when making decisions about you.
• An expression of your consent or your refusal of consent to medical care.

The idea of advance care directives or advance care plans has been around for a long time.

No matter whether you call it an Advance Care Directive or an Advance Care Plan or an advance care planning document, they are a valid expression of a person’s consent or of their refusal of consent, in advance of incapacity.

Incapacity means you have lost the capacity to make or speak your decisions or wishes.

Your advance care directive or plan can only be used to make decisions about your care when you cannot- ie when you lose capacity.

Health practitioners are obliged to consider any expression of a person’s wishes for medical care.

They cannot ignore an expression of consent or refusal of consent.

Touchstone Life Care’s Advance Care Plans are not the same as a Statutory directive, which are different in every state, (and do not exist at all in NSW and Tasmania) These have a variety of names; some are called Health Care Directives, others a State Advance Care Directive or Personal Statement of Health.

An Advance Care Plan will not cover all treatments – only the ones you specify. It is important to as clear and specific as possible about what treatments you do and do not want.

An Advance Care Plan also cannot compel a health practitioner to withhold palliative care, assist you to die, or give you treatment which is futile.

Since it is not possible to cover every conceivable treatment in an Advance Care Plan, Touchstone’s Advance Care Plan allows you to set out what is important to you, and the things you need to live your minimum quality of life – such as being able to communicate with your loved ones. These values will guide health practitioners when treating you by enabling them to assess whether you would have consented to particular treatment in a given circumstance. For example, if life-saving brain surgery would inevitably leave you non-communicative (eg. in a permanent vegetative state) and you have indicated you do not want to live this way, your doctors might decide against performing such surgery.

Note that setting out your values alone (without being specific about treatment) will be open to interpretation. In the example given, a decision to operate could be made if it is believed you might be able to communicate with assistance, and therefore would have consented on the basis of your values.

Therefore if there is treatment you absolutely want to exclude, you must be very specific about that in your Advance Care Plan. The more specific and clear about the treatment you consent or refuse consent to, the greater likelihood you wishes will be followed.

An Advance Care Plan is a document which sets out your wishes in relation to medical care. It expresses your consent, or refusal or consent in advance. Unlike powers of attorney or guardianship, an Advance Care Plan in itself does not empower another person to make a decision for you.

A person who makes medical treatment decisions on your behalf, if you lose decision-making capacity, is generally referred to as a substitute decision maker. A substitute decision maker must have regard to your wishes, including those set out in your Advance Care Plan. This is because a substitute decision maker must decide your medical treatment in accordance with what they believe you would have wanted (and not in accordance with what they believe your best interests are).

Every state and territory in Australia has different laws around powers of attorney and guardianship. Depending on your state or territory and individual circumstances, your substitute decision-maker might be your power of attorney, or a guardian.

If you lose decision-making capacity, medical treatment may be lawfully given without your consent in an emergency if:

it is not known whether you consent; or
you are not known to have previously refused consent.

In these circumstances, treatment decisions will be made on the basis of your best interests, as assessed by others. However, if you have a valid Advance Care Plan in which you refuse consent to treatment such as a blood transfusion or CPR, you cannot lawfully be given this treatment – even if it is in your best interests.

If a copy of your Advance Care Plan is not immediately available in the event of an emergency, a health practitioner may need to administer life-saving measures until they can contact your next of kin. It is therefore crucial to ensure your loved ones are aware of your Advance Care Plan and understand its contents.

Touchstone’s Advance Care Plan is intended for use in Australia only. It would be up to health practitioners or carers overseas to decide how much they rely on your Advance Care Plan in the event you lose decision-making capacity.

If you intend to relocate overseas, we recommend you speak to a doctor or lawyer locally about how to make an Advance Care Plan.