Frequently asked questions
- What is advance care planning?
- Why do advance care planning?
- What is an Advance Care Plan?
- Who can make an Advance Care Plan?
- Who do I tell?
- Who should I choose to make decisions for me?
- Do I need a lawyer to complete an Advance Care Plan?
- Can my Advance Care Plan be changed or revoked?
- When is an Advance Care Plan used?
- What if I become ill or I am injured while I am away from home?
- What happens in an emergency?
- Does a Doctor have to follow an Advance Care Plan?
- How is this different to euthanasia?
- What is the difference between advance care planning and advance directives?
What is advance care planning?
All adults with decision making capacity have the right to have a say in their health care, now and for the future. Making decisions about future medical treatment is called advance care planning. Decision-making about medical treatment needs to involve being fully informed about the medical condition and benefits and burdens of treatments.
Advance care planning involves thinking about and discussing with doctors, family, carers, and other important people, the medical treatments wanted or not wanted if you or the person making the advance care plan were unable to communicate or make medical decisions and were seriously ill, had an accident or were dying.
Why do advance care planning?
Advances in medical technology have given medicine the ability to prolong life through artificial or mechanical means. These advances have created their own dilemmas, especially when the treatments may be of limited or no benefit to the patient. Doctors and family can find themselves having to decide for the patient when to withhold or withdraw life-sustaining treatments when the patient can no longer communicate their own decision. Advance care planning enables a patient's wishes and views to influence this discussion and decision.
Planning treatment choices, in advance of any problems occurring, gives those who will be undertaking the caring, the opportunity to respect their loved one’s choices. If, in the future, a person became unable to express their choices for treatment, their doctors and family/significant others may not know what their loved one would want and this can become a very difficult experience. Discussing choices now can be a comfort and of assistance to family/significant others in the future.
What is an Advance Care Plan?
An Advance Care Plan is a written or verbal record of a person’s choices about their future medical care. An Advance Care Plan is only used when the person is no longer able to make or communicate their own decisions about their medical treatment. It works as a guide to the substitute decision makers and doctors who are making medical treatment decisions.
An Advance Care Plan can include:
- nomination of another person to make decisions (process depends on State and Territory legislation)
- an oral discussion
- a letter written by the patient documenting their choices
- a Statement of Choices or Wishes outlining future medical treatment wishes and psychological, environmental, social and spiritual requests
Who can make an Advance Care Plan?
Any adult who has the capacity to make their own medical decisions can make an Advance Care Plan. If you develop a disability that leaves you unable to make your own decisions about medical treatment, eg a brain injury or dementia, you will not be able to appoint a substitute decision maker or prepare your own Statement of Choices.
Who do I tell?
Think about the treatment you would want and talk about it with your family/ significant others and your doctor. It may be hard for you and your family/those close to you to face some of the questions and information, but thinking about the medical treatment that is important to you is no different to putting thought into your life insurance, your will or planning for many aspects of your future.
- Talk to your family and to those most likely to be involved in making decisions if you are very ill. A close or loving relationship does not always mean that the other person knows or understands your wishes for future medical care.
- Talk to your doctor.
They can help you to understand your current health and what may happen in the future. They may assist you to make sure your Advance Care Plan is clear and complete. Give your doctor a copy of your completed Advance Care Plan.
- Talk to a Respecting Patient Choices Consultant (if available) and they will help you to discuss these issues with your family and doctor.
- Talk to significant others involved in your care
It can also be helpful to discuss advance care planning with a nurse, social worker or religious advisor to talk through some of the issues and questions that you may have. Questions regarding medical treatments need to be addressed to your doctor, however it may be helpful to have a friend or other person involved in your care present with you when you discuss these questions.
- Who will listen carefully to your beliefs, values, goals and wishes for future medical care and follow them, and
- Someone who will be comfortable making decisions in difficult situations.
- Usually the appointed substitute decision maker is a family member, but it can be anyone you trust.
For further information, see Module 2
Do I need a lawyer to complete an Advance Care Plan?
In nearly all (except Qld) States and Territories the law does not require you to have a lawyer to complete your Advance Care Plan. Your doctor or a Respecting Patient Choices Consultant (if available) can help you to complete your Plan.
For further information, see Module 2
Can my Advance Care Plan be changed or revoked?
Yes. You can change your plan at any time while you are still legally able to make medical decisions for yourself. Your Advance Care Plan can also be revoked at any time by telling your substitute decision maker that their legal role has been withdrawn and by destroying all copies of the Advance Care Plan (including the legal appointment document). In some States and Territories you may also be required to complete a revocation form (check).
For further information, see Module 2
When is an Advance Care Plan used?
It is only used if you are unable to make or communicate your own decisions. It would guide the decision making of your doctor, your substitute decision maker and family.
What if I become ill or I am injured while I am away from home?
The best way to ensure that you receive the type of care you want is to discuss your choices with your substitute decision maker and family. Also, make sure that they have a copy of your Advance Care Plan and they take it to any organisation you are receiving care from.
What happens in an emergency?
When there is an emergency, and your medical record is not available, life-sustaining measures may be started. Following discussions with your substitute decision maker and family, treatment can be stopped if it is clear that it is not what you would have wanted.
Does a doctor have to follow an Advance Care Plan?
This depends on a number of factors, some of which are: how clear the document is, whether it applies to the decision, and if there is any disagreement among loved ones. Documents should be created in an attempt to resolve these issues. Sometimes a doctor will not follow a document because of personal beliefs. In this case, institutional policy and often state statute/laws require the doctor to offer transfer of care to another doctor.
How is this different to euthanasia?
There are very significant differences between advance care planning and euthanasia. Advance care planning is the process of discussing and choosing future health care and medical treatment options. The process of individuals making decisions about their own medical treatment is legally supported in Australia. Euthanasia is the practice of actively terminating life to hasten death. Euthanasia is illegal in Australia.
What is the difference between advance care planning and advance directives?.
Advance care planning refers to “the process by which patients, together with their families and health care practitioners, consider their values and goals and articulate their preferences for future care." (Tulsky, 2005, p.360)
As a result of advance care planning an Advance Care Plan (ACP) may be developed. This usually includes some form of formal written documentation, but could also include a letter or be verbal. Part of an ACP may also be documentation around the appointment of a surrogate decision maker.
An advance directive is a type of formal written document which might be included as part of an Advance Care Plan. Some states and territories have developed legislation which ensures that documentation of a patient’s directives about their future treatment are legally binding. If these documents have been completed, the patient’s agents, next-of-kin and doctors are obliged to follow them. The power of these advance directives and conditions attached to them are specific to each state and territory.