Advance Care Directives (‘ACDs’) are one of 3 testamentary documents commonly utilised by clients, along with Wills and Enduring Powers of Attorney. ACDs are designed to allow individuals to make plans for their future care and to exercise freedom of choice during serious illness and end of life care. We often recommend to clients that they draft and sign an ACD because Australia’s population continues to rapidly age and medical and technological advances prolong life. In this blog we will explain why we make this recommendation.
Firstly, let us look at what exactly an ACD does. It allows the person undertaking the ACD to appoint one or more Decision Makers, to make choices on the person’s behalf, with regards to their medical care. Decision Makers can be appointed separately (meaning that one person is appointed, then if they are unable or unwilling to act, a different person will be appointed), or jointly (meaning they must make decisions together).
The ACD contains 6 ‘values and wishes’. These areas ask the person to explain things that are important to them and that they want taken into consideration when decisions are being made for them. They can also make requests for the kind of health care they would prefer to receive or not receive, and their wishes for how to handle remains, such as burial, cremation and/or organ donation.
These 6 clauses are not binding. They explain the persons wishes, but they are exactly that. The Decision Maker is required to adhere to these wishes as much as possible, but where it is impractical or impossible, they are not sanctioned from making decisions outside of, or even contradictory to, the wishes. It is therefore common that the wishes explained in these clauses are not demanding in nature, but more explanatory of how you would like to be cared for, and what considerations are most important to you when being cared for.
The ACD also contains one binding clause, a binding refusal of healthcare. This clause allows the person to explain what healthcare they do not want to receive, and this refusal will be binding on the Decision Makers and any medical professionals providing care. Generally, this clause is used to bindingly refuse ‘life-sustaining treatment’, in the circumstance where there is no chance of recovery or other treatment (such as the terminal phase of terminal illnesses, persistent comas, etc.). However, whilst this is the standard use of this clause, it is not the only option and any healthcare that may be legally refused were the person capable of making the decision themselves, may be included here.
So in summary, the document consists of 6 non-binding clauses containing wishes and considerations for Decision Makers to base their decisions on, and 1 binding clause that refuses specific healthcare in specific circumstances.
The types of things people insert in their ACD are:
- It is important to me to continue my relationship with family and friends
- It is important to me to be independent
- I wish to be kept pain free
- I wish to remain at home with home care for as long as possible. If necessary, I will enter supported care (or “I am happy to enter supported care”, or any variation of this)
- I wish to be cremated (and specifications regarding scattering or keeping of ashes)/I wish to be buried (with details of a plot, if necessary)
- I wish/do not wish to be an organ donor
- I wish to have access to the outdoors
- I wish to continue playing sport for as long as possible, or to be involved with sport for as long as possible
- I wish for music to be playing in my home
- I wish to be kept well groomed and presentable
These are just some of the things included. As you can see, they are varied and can be as detailed or vague as you choose. Some people ask to be surrounded by plants, or to be clothed a specific way. It is an entirely personal choice and serves as a guide to whomever is caring for or making decisions for the person.
We hope this sheds some further light as to the purpose of an ACD and its potential application. Whilst some of it may seem somewhat frivolous, it can be particularly helpful to Decision Makers to be aware of what the person for whom they are deciding, considers important. Furthermore, the binding refusal of healthcare clause is especially important in letting those caring for you (family or medical professionals) know how to handle such a difficult situation.
Our team has extensive experience in this area so if you have any further questions, or wish to discuss any of the above, please feel free to contact us on (08) 7001