Advance Care Planning

Advance Care Planning

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

This includes thinking about your values, 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.

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

Watch some videos on Advance Care Planning from our events below or on our Youtube Playlist:

Advance Care Planning in the ACT

There are three ways your choices can be shared with health professionals through Advance Care Planning:

  1. Complete an Enduring Power of Attorney (EPoA), including appointing someone to make decisions on your behalf.
  2. Complete a Statement of Choices.
  3. Complete a Health Direction under the Medical Treatment (Health Directions) Act 2006.

You may complete just one or all of these forms. 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.

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.

Canberra Health Services 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]

Their Advance Care Planning team holds clinics each week to help people complete their forms:

WhenWhereHow to Book
MondaysThe Canberra Hospital, Garran

North Canberra Hospital, Bruce

Call the ACP team on 5124 9274 or email [email protected]
TuesdaysThe Canberra Hospital, Garran
ThursdaysUniversity of Canberra Hospital, Bruce
Council on the Ageing ACT, HughesCall COTA ACT on 6282 3777

Advance Care Planning Documents

If you live in NSW, the forms are different. You can learn about planning in NSW and download the forms from Advance Care Planning Australia. You can still share your plan with health services you use in the ACT.

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 condition that affects decision-making.  You can appoint more than one attorney if you wish. Enduring Powers of Attorney are governed by the Powers of Attorney Act 2006.

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.

You can download a copy of the Public Trustee and Guardian’s Power to Choose guide, including the forms or contact us for a paper copy.

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 says that this statement 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.

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.

You can see more examples and fill in your statement of choices using the Advance Care Plan Statement of Choices (Competent Person) booklet from ACT Health or contact us for a paper copy.

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

If your Health Direction and Enduring Power of Attorney say different things, your decision makers will use the most recently dated one.

You can download the Health Direction form from ACT Health. It is recommended that you complete this form with help from your treating doctor.

To make your wishes known you need to share your Advance Care Plan. To lodge it with Canberra Health Services, you can:

  • upload it to your ACT Digital Health Record through My DHR,
  • mail a copy to
    Canberra Health Services – Health Information Service
    PO Box 11
    Woden ACT 2606
  • or email a scanned copy to [email protected].

You should also share a copy with:

  • your attorney/s or decision makers,
  • your family,
  • your GP,
  • and other hospitals you are admitted to.

It is also a good idea to upload it to My Health Record so it can be used if you are outside the ACT.

Involving Others in Advance Care Planning

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. If you have a major health condition, your GP or specialist can help you understand what life-prolonging treatments you should think about when deciding what you want.

Help 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 of people with chronic health conditions and their carers.  If you are interested, please contact HCCA on 6230 7800 or by email.

You can get help with your Advance Care Planning and documentation by contacting the Canberra Health Services Advance Care Planning team on 02 5124 9274. 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.

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.

More to think about…

If you are thinking about advance care planning, particularly if you have a long term health condition, you may also want to think about:

  • Creating a will
  • Financial matters, such as mortgages, insurance, and superannuation
  • Legal matters
  • Care and housing arrangements

The following list has some resources that you can use. Inclusion on this list is not an endorsement by HCCA. These are suggestions only.

Will kits are available from most post offices for a simple will. However, wills have to meet legal requirements so it’s a good idea to seek help writing your will.

Private lawyers can help with wills, EPOA and estate planning issues. Use the ACT Law Society search to find one.

The Public Trustee and Guardian has advice for making your will. They can help you to write a will or EPOA for a lower fee. You can download Power to Choose, a guide to Enduring Powers of Attorney, from their website.

It may be cheaper to prepare both your will and Enduring Power of Attorney at the same time.

It is important to document your accounts and insurance information for your loved ones. You can use a template like this one: Personal Information Record and store it securely with other important documents.

Services Australia has a free Financial Information Service that can help you understand financial matters and your financial options.

The Money Smart website has tips to help you choose a registered financial adviser: Choosing a financial adviser – You can search for a registered adviser on the Money Smart website.  Your superannuation fund or bank may also be able to help you find a registered financial adviser

People under the age of 65 can apply for disability support from the National Disability Insurance Scheme (NDIS). Learn how to apply.

Feros Care is the Local Area Coordinator for the NDIS in the ACT. You can contact them for support to understand the NDIS, and for help with your access application. Visit them at Suite 4, 2-6 Shea Street Phillip or call 1300 986 970.

People over the age of 65 may be eligible for My Aged Care. If you need help understanding and applying for aged care services and don’t have anyone to support you, you can contact a Care Finder.

Last Updated on 19 March, 2024.