Healthy living

Advance Health Directives

  • An Advance Health Directive (AHD) is a legal written document, containing your decisions about your future health treatment.
  • Anyone over 18 can prepare an AHD – even healthy people prepare AHDs.
  • If you lose your mental capacity, you are not legally allowed to prepare an AHD and nobody else can do it for you.

In WA, the law allows you to write an AHD to say what treatments you want or don’t want in specific circumstances. Or you can appoint someone to make medical treatment, personal or lifestyle decisions on your behalf, when you are unable to make or communicate your decision.

You can make an AHD in which you either provide consent, or refuse consent, to future treatments. For example, you may say that you want or do not want a certain treatment. An AHD can only be completed while you have the ability – or ‘mental capacity’ – to make and communicate decisions. As soon as you lose the capacity to make and communicate decisions, you are no longer able to complete or modify an AHD. No one else can complete an AHD for you once you have lost capacity.

Listen to information about AHDs (MP3 2.9MB, 7:12 min) or read the audio transcript.

What is an Advance Health Directive?

An Advance Health Directive is a legal document in which a person may indicate whether they would consent or refuse particular treatments in particular circumstances.

For example, a patient who has been diagnosed with cancer. If their disease has reached a stage where they and their doctors know they are incurable, the medical treatments being received are simply to keep the patient comfortable. They may wish to write in an Advance Health Directive that if the situation arose wherein they developed a condition e.g. pneumonia which could end their life, that they will refuse treatments which can treat the pneumonia but will wish to accept treatments such as oxygen, nutrition and pain killers to keep them comfortable.

Another example, many people have a fear of an accident or other trauma which may leave them in a coma, sometimes called a persistent vegetative state. They worry that they may be kept alive indefinitely in an intensive care unit, being supported by drugs and ventilatory support and other treatments. In that case, they may wish to say that they will accept these treatments for a finite length of time until it is clear that they will not make any significant recovery. For example, they may indicate that if after 3 months of this treatment if it is clear that they will not recover from the coma, then they wish the treatments to be withdrawn.

Some people will be familiar with the term “living wills”. An Advance Health Directive is a similar document, which people can use to indicate what treatments they consent or refuse to receive in particular situations. The important thing to remember is that the Advance Health Directive only comes into effect if and when the patient is unable to make or communicate decisions for themselves. It is also important to remember that you can change your mind about an Advance Health Directive – you can either update it or revoke it.

Why should I make an Advance Health Directive?

You have the right to make decisions about your own health care and treatment. But what will happen if you're not able to make your choices known? Some people, due to personal experience, religious beliefs or advice from loved ones, feel it is important to specify treatments they want, or do not want to receive in the future. You do not have to prepare an AHD – it is a very personal choice. It is up to you to decide whether completing an completing an AHD is right for your or not.

By doing an Advance Health Directive or appointing an Enduring Guardian, you will hopefully be having conversations with your doctors and therefore have a better understanding of what is happening to you. Also, this will allow your carers to have a better idea of what medical treatment you want, what is important to you, and what you think is a reasonable quality of life and so on.

Rather than encouraging everyone to make a directive, people are encouraged to talk about these issues, which are often very difficult to start.

What if I don't choose to make an AHD?

If you have chosen not to make an AHD, a treatment decision will be made on your behalf if you lose the capacity to make the decision for yourself.

Many people believe that their next-of-kin (father, mother, husband, wife or children) has authority to give or refuse consent for their treatment. This is untrue.

There is a hierarchy of decision makers (treatment hierarchy) that health professionals are required to follow, which is designed to give the authority to those who are most likely to know your beliefs and wishes.

If a person identified as being a decision maker (also known as the person responsible) is not contactable or readily available or declines to make a decision, health professionals need to contact the next person responsible in the hierarchy of decision makers. The treatment decision will be made by (in the following order of priority). Please refer to the diagram below, Hierarchy of decision makers, also known as the treatment hierarchy.

If your treating health professional does not acknowledge (or accept) your partner as your decision maker, your partner should contact the State Administrative Tribunal (SAT) (external site) on 1300 306 017 (local call rates from land line only).

View the hierarchy of decision makers (PDF 69.6KB).

Can I be forced to sign an AHD against my will?

A treatment decision contained in an AHD which was not made voluntarily or which was made as a result of an inducement or coercion will be invalid.

In circumstances where it is suspected that an AHD was not made voluntarily or was influenced by inducement or coercion, it would be appropriate to make an application to the State Administrative Tribunal (external site) for a determination of (in)validity.

What is an Enduring Power of Guardianship?

The Enduring Power of Guardianship enables a person to appoint someone or several people whom they trust and who knows them well to make decisions about their medical, lifestyle and other personal matters on their behalf if and when they are unable to make or communicate those decisions for themselves.

This is particularly useful because it is not always possible in either an Advance Health Directive or a living will to anticipate every scenario that may happen to you. Therefore, having someone who can speak on your behalf who knows what you want is another way of ensuring that what you want to happen to you when you are unable to communicate actually happens.

A person can have both an Advance Health Directive and an Enduring Guardian, or just an Advanced Health Directive or just an Enduring Guardian.

Read more about Enduring Power of Guardianship.

Are doctors obligated to respect the directive if there is one in place?

Doctors and other health professionals are obliged to respect the directive, be it an Advance Health Directive or one given by an Enduring Guardian on behalf of the patient. It is important to remember that it is not only doctors who are bound by this legislation. The law applies to all health professionals that are caring for a patient.

For example, a person who is at a terminal stage of their illness and who lives in a care facility e.g. a nursing home with which they are familiar, can decide that they don’t want to die in a hospital. Instead, they may just wish to be kept comfortable in their current nursing home. If they indicate this in their Directive, the care facility is bound to respect it.

How will they know that someone has written an Advance Health Directive?

Healthcare professionals cannot honour something that they do not know exists. It is the responsibility of the patient to make sure that everyone who may be involved in their care is aware that they have written an Advance Health Directive or appointed an Enduring Guardian or both.

We suggest that they give copies to their general practitioners, other doctors looking after them, the hostel or nursing home if they are in one, their family members and so on. They may wish to carry a card in their wallet to indicate that they have an Advance Health Directive and where to find it. If they have an Enduring Guardian, they may wish to have this information and the contact details of the guardian in their wallet. They may also wish to have a MedicAlert bracelet to indicate this.

Likewise, if a person revokes their Advance Health Directive or updates it, it is the person’s responsibility to let everyone who needs to know, know this.

Will these directives be available in a language other than English?

It can be difficult to write an Advance Health Directive in any language but it is suggested that if you want the health care professional to respect your wishes, you have to make it easy for them to do so. And, at present, that means that your directions need to be clear and therefore in English.

Imagine the situation where you were in an emergency situation and your Advance Health Directive is written in a language other than English. It is not possible to respect an Advance Health Directive if one doesn’t know whether the Directive gives orders for a particular emergency situation and if so, what those orders may be. Although in an ideal world, a translation could be obtained quickly, we need to anticipate that this may not happen.

Sometimes, you have to make it easy for people to do what you wish them to do. That means making the Advance Health Directive easy to understand. The Office of the Public Advocate provides advice as to what a patient may do in this situation e.g. get the Advance Health Directive translated in advance.

Can people review their Advance Health Directives?

Certainly, people are encouraged to review their Advance Health Directive whenever their condition or situation changes or every 2-5 years. Just remember, that if you do update your Advance Health Directive, you must let everyone who is involved in your care know about the changes.

Where to get help

Advance Health Directives

WA Cancer and Palliative Care Network, Advance Care Planning telephone support
Phone: (08) 9222 2300
Email: acp@health.wa.gov.au

Enduring Powers of Guardianship
Office of the Public Advocate
Phone: 1300 858 455 (local call rates from land line only)
Fax: (08) 9278 7333
Email: opa@justice.wa.gov.au

More information


Acknowledgements

Cancer and Palliative Care Network


This publication is provided for education and information purposes only. It is not a substitute for professional medical care. Information about a therapy, service, product or treatment does not imply endorsement and is not intended to replace advice from your healthcare professional. Readers should note that over time currency and completeness of the information may change. All users should seek advice from a qualified healthcare professional for a diagnosis and answers to their medical questions.

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