Advance care planning is recording what you want done, or not done, when you can no longer speak for yourself about your health. You must make these decisions while you still can. An Advance Care Plan only comes into effect if you are unable to make decisions.

Advance care planning is thinking about these issues, talking to your loved ones about what you want, deciding who you trust to make decisions for you when you can’t make them for yourself, and completing the right legal documents.

It is one of the things we often have on our ‘To Do List’ but never quite get around to doing.

Advance Care Planning is a conversation everyone needs to have. It may not be an easy conversation, but it is important to help your loved ones make decisions at a time when they are distressed or unsure about what is the best thing for you.

You can change or add information to an Advance Care Plan at any time. So if your circumstances change or what you want changes, you can update your Advance Care Plan to make sure your current wishes are included.

If you are able to make decisions, you can make a choice that is different to what is recorded in your Advance Care Plan.

Advance Care Planning in the ACT

Who would you like to make medical decisions for you if there came a time when you could no longer speak for yourself?

In an emergency situation, an Advance Care Plan provides medical teams with the necessary information to make decisions that reflect what the patient wants, even if they can’t tell them at the time.

There are three ways your choices can be conveyed to health professionals through Advance Care Planning:

1. Complete an Enduring Power of Attorney (EPA).
2. Complete a Statement of Choices.
3. Complete a Health Direction under the Medical Treatment (Health Directions) Act 2006.

Having a Power of Attorney, completing a Statement of Choices and/or a Health Directive can help you to:

• Make your wishes known about the type of medical treatment you want if you can’t actively make decisions about your medical care.
• Protect your right to refuse unwanted medical treatment and to ensure you get suitable relief from pain and suffering.

ACT Health offers help with advance care planning that gives you a way to discuss, record, and document your health care wishes.  It is designed for the ACT health and legal systems.  You can find out more on the Canberra Health Services website and by contacting the Advance Care Planning Program, Quality and Safety Unit, 5124 9274 or [email protected]

Types of Advance Care Planning

 Enduring Power of Attorney (EPA)

An Enduring Power of Attorney gives you the power to choose a relative or friend to manage your health care, personal care and financial affairs should you become incapacitated or if you develop a decision-making disability.  You can appoint more than one attorney if you wish. In the ACT your spouse or next of kin have no legal entitlement to make formal substitute decisions on your behalf unless there is an Enduring Power of Attorney in place.

You can choose the decision-making areas you give to your enduring attorney/s which can include any or all of the following areas or functions:

• Financial and Property
• Personal Care
• Health Care

When selecting someone to be your attorney it is important to choose someone who:

• You trust and who knows you well
• Is over 18 years of age
• Is willing to respect your views and values
• Is able to make decisions under circumstances that may be difficult or stressful

Often a family member is a good choice as an attorney, but not always. Make sure that you choose someone who will closely follow what you want and will be a good advocate for you.

If you choose not to complete an Enduring Power of Attorney and you become unable to legally make or communicate decisions for yourself, any medical decisions could be made by a Guardian appointed by the ACT Civil and Administrative Tribunal (ACAT) under the Guardianship and Management of Property Act 1991.

Statement of Choices

The Statement of Choices is a document used to guide future medical decisions when you lose the ability to make or communicate your medical decisions yourself.

The law requires that this statement of your wishes must be taken into account when determining your treatment. The Statement of Choices is designed to inform your attorney (the person you have chosen to make decisions on your behalf) and the doctors  about your medical treatment wishes. It is not legally binding, unlike an Enduring Power of Attorney or a Health Direction under the Medical Treatment Act 2006. If you become unable to make decisions, this information will assist your attorney/s (or Guardian) and doctors in making decisions that are in line with your expressed views and best interests.

You need to think about when you would not want life prolonging treatments.  The types of treatment available can include:

• CPR (Cardio Pulmonary Resuscitation)
• Breathing machines (ventilator)
• Kidney machine (dialysis)
• Artificial feeding (intravenous, nasal or PEG tube)
• Antibiotics
• Blood transfusion

You need to think about what is an acceptable level of ability or independence (e.g. self care, toileting, speaking) and your ability to participate in the thing that you enjoy.   You can then decide what a reasonable outcome of medical treatment is that you would be willing to live with and then record this in the Statement of Choices.  For example, you may say in your Statement of Choices that if you are unable to communicate with or recognise your family, and there is no possibility that you will ever recover or improve, then you do not want CPR if your heart stops, and you only want to be kept comfortable and free from pain.

Health Directions

In the ACT you can also give legally binding directions about medical treatment that you do not want now, and in the future, by completing a Health Direction under the Medical Treatment Act 2006. This is a legal document that gives competent adults the legal right to refuse or withhold medical treatment.

The Enduring Power of Attorney and Health Direction are legal documents that comply with the Medical Treatment (Health Directions) Act 2006. The Statement of Choices provides specific information relating to a person’s wishes and values but it is not legally binding.

Involving Others in Advance Care Planning

You can get assistance with your Advance Care Planning and documentation by contacting the Canberra Health Services Advance Care Planning team on 5124 9274.

Calvary Health Care also has an advance care planning system and set of documentation developed by their national organisation, the Little Company of Mary Health Care.

Partner, Family and Friends

You need to discuss your wishes for medical care with your family and other significant people in your life. It is important to ensure that these people clearly understand your wishes and any instructions you want to give.

If you do not discuss your medical treatment wishes with the important people in your life, they could well ask for care and treatment on your behalf without understanding the implications and that the treatment may be against your wishes.

 Medical Practitioners

Family doctors such as your general practitioner can play an important role in assisting with decisions about your medical care.

Help with Advance Care Planning

There are a range of services available in the ACT to help you with Advance Care Planning.

The Health Care Consumers’ Association (HCCA) has a range of resources to assist consumers with advance care planning. They can also provide an introduction to advance care planning information session for groups.  If you are interested, please contact HCCA on 6230 7800 or by email.

There are also trained facilitators and consultants available through the Advance Care Planning Program run by Canberra Health Services. They are available to talk to groups and individuals to explain and facilitate discussion around the importance of advance care planning for anyone over the age of 18 years. Facilitators can also help guide individuals through the process of completing your own Advance Care Plan and Enduring Power of Attorney.

The office of the Public Trustee and Guardian can provide information and assistance with Enduring Power of Attorney, as can your own solicitor.  The ACT Public Advocate has developed a guide on completing a power of attorney in the ACT.

General practitioners can assist with decisions about your medical care.

The BeMyVoice website provides advice and guidance on advance care planning and includes consumer stories that might raise issues you haven’t thought of. It also provides links to the documentation and forms needed such as:

• Enduring Power of Attorney (EPA).
• Statement of Choices.
• Health Direction form used under the Medical Treatment (Health Directions) Act 2006.

Advance Care Planning Australia have a lot of information and resources that are designed specifically for consumers and carers in the ACT.  You can also speak to one of their consultants on the phone to help with your planning. Their contact number is 1300 208 582.