Talking about future medical care can feel uncomfortable. However, recording your wishes while you can make your own decisions gives health practitioners and the people close to you clearer guidance if you cannot communicate those wishes later.
Advance care planning is the broader process of thinking about your future healthcare, discussing your preferences and deciding who you trust to speak for you. An advance care directive is the legal document used to record certain treatment instructions, values and preferences.
This guide explains how advance care directives work in Victoria, what they can cover and what families should understand before helping someone begin the process.
This article provides general information about Victorian advance care planning. It is not medical or legal advice.
What Is an Advance Care Directive?
An advance care directive is a legal document that records a person’s instructions, values or preferences for future medical treatment. It is used if the person later loses the decision-making capacity required for a particular medical decision.
The person must make the directive themselves while they have the capacity to understand and communicate their decisions. A family member cannot create one on another person’s behalf after that person has lost capacity.
An advance care directive is different from:
- A will, which deals with property and other matters after death
- A power of attorney, which may cover financial and personal matters
- An appointment of a medical treatment decision maker
- A general care plan prepared by a service provider
These documents serve different purposes and may form separate parts of a person’s future planning.
How Advance Care Directives Work Under Victorian Law
Advance care directives in Victoria are governed by the Medical Treatment Planning and Decisions Act 2016.
A directive may contain one or both of the following:
Instructional directive
An instructional directive records legally binding instructions consenting to or refusing specific future medical treatment.
The wording must clearly identify the treatment and the circumstances in which the instruction applies. Because health practitioners are required to follow a valid and relevant instructional directive, it should only be completed when the person understands the treatment they want to accept or refuse.
Discussing an instructional directive with a doctor can help ensure the wording is medically clear and reflects an informed decision.
Values directive
A values directive records the person’s values, preferences and priorities for future medical treatment. It may explain what quality of life means to them, where they would prefer to receive care or what matters most when treatment decisions are made.
Unlike an instructional directive, it does not provide binding consent to or refusal of a particular treatment. It guides the medical treatment decision maker and health practitioners when they need to decide what the person would have wanted.
A directive can include either type or both. Completing a new advance care directive ends an earlier version, so outdated copies should be collected or clearly marked to prevent confusion.
Medical Decisions an Advance Care Directive May Address
Advance care planning is not limited to the final stage of life. A directive may address treatment decisions that could arise after an illness, injury or change in health.
Depending on the person’s circumstances, it may cover:
- Resuscitation
- Life-sustaining treatment
- Surgery or other specific medical procedures
- Treatment for an existing or expected condition
- Preferences concerning pain relief and comfort
- Personal views about independence and quality of life
- Preferences about receiving care at home where possible
An instructional directive should describe a specific treatment decision clearly. Broader preferences, such as wanting to remain comfortable, stay connected with family, or receive care at home, are generally more suitable for a values directive.
A preference recorded in a values directive will guide future decisions, but it cannot guarantee that a particular service or place of care will be available.
Appointing a Medical Treatment Decision Maker
A person can formally appoint one or more adults as their medical treatment decision maker. This person only makes a medical decision when the patient does not have capacity to make that particular decision themselves.
The decision maker must consider the person’s advance care directive, previously expressed preferences and values. Their role is to make the decision they reasonably believe the person would have made, not the decision the family member personally prefers.
Choosing someone directly allows the person to appoint an individual they trust to understand and represent their wishes.
Who Makes Decisions When Nobody Has Been Appointed?
If no medical treatment decision maker has been formally appointed, Victorian law provides an order for identifying one.
The decision maker is the first person who is reasonably available and willing and able to act:
- A medical treatment decision maker appointed by the patient
- A guardian appointed by VCAT with authority over medical treatment
- A person in a close and continuing relationship with the patient, in this order:
- Spouse or domestic partner
- Primary carer who is not a paid service provider
- Adult child
- Parent
- Adult sibling
When two or more relatives are at the same level, the eldest person takes priority.
If no medical treatment decision maker can be identified, the health practitioner may need to contact the Public Advocate for a decision about significant treatment. Different rules apply to routine and emergency treatment.
A Support Person Has a Different Role
A support person is not the same as a medical treatment decision maker. A person can appoint a support person to help them:
- Collect and understand medical information
- Communicate with health practitioners
- Explain their own decisions
- Give effect to the decisions they make
The support person helps while the individual is making their own decisions. They do not receive authority to make medical treatment decisions on the individual’s behalf.
A person may appoint both a support person and a medical treatment decision maker because the two roles apply in different circumstances.
Recording Preferences About Palliative Care at Home
Palliative care focuses on comfort, symptom management and quality of life. Depending on the person’s clinical needs, home environment and available services, some palliative care may be delivered at home.
Someone who would prefer to remain at home can record this in a values directive and discuss it with their family, GP and healthcare team. The directive may also explain what comfort, dignity, independence and family involvement mean to them.
Recording the preference helps guide future planning, but it does not guarantee that care at home will always be clinically suitable or available. The healthcare team will still need to consider the person’s condition, safety, support requirements and local service availability.
Advance care planning should also not be confused with voluntary assisted dying. They are separate processes governed by different legal requirements.
How to Make an Advance Care Directive in Victoria
A person making an advance care directive must have decision-making capacity for each statement included in the document.
Decision-making capacity generally means the person can:
- Understand the information relevant to the decision
- Understand the possible effect of the decision
- Retain the information long enough to make the decision
- Use or weigh the information when deciding
- Communicate the decision in some way
A person may still have capacity when they require reasonable support, such as additional time, accessible information, an interpreter or a communication aid.
The practical steps include:
- Think about future treatment preferences, values and priorities.
- Discuss these wishes with trusted family members or other important people.
- Speak with a GP or relevant health practitioner, especially before writing treatment instructions.
- Download the current Victorian advance care directive form and instructions.
- Complete the relevant instructional or values sections.
- Sign the directive in front of the required witnesses.
- Give copies to the appropriate people and healthcare services.
The Victorian Department of Health provides the current forms and completion instructions free of charge.
Getting the Witnessing Requirements Right
In Victoria, an advance care directive must be signed in front of two adult witnesses. One witness must be a registered medical practitioner. Neither witness can be the person’s appointed medical treatment decision maker.
The witnesses must be satisfied that the person:
- Appears to have decision-making capacity for each statement
- Understands the nature and effect of the directive
- Is signing freely and voluntarily
Witnessing must take place in person and cannot be completed through an audiovisual link. Following the instructions supplied with the current Victorian form is important because incorrect signing or witnessing may affect whether the directive is valid.
Storing, Sharing and Reviewing the Directive
An advance care directive is only useful if the relevant people know it exists and can access it when needed. Copies may be given to:
- The appointed medical treatment decision maker
- Close family members
- The person’s GP
- Relevant specialists or treating services
- A hospital where the person receives care
The document may also be uploaded to My Health Record. A person should review the directive after a major diagnosis, change in health, change in relationships or shift in personal preferences. If changes are needed, a new directive should be completed and old copies replaced.
Starting the Conversation Without Creating Pressure
Bringing up advance care planning with a parent or older family member can feel difficult. The conversation is usually easier when it begins before a health crisis.
A family member can open the discussion by asking what matters most to the person if their health changes. The aim should be to understand their wishes, not persuade them to make particular treatment choices.
Similar principles apply when an older parent is reluctant to accept support: listen carefully, respect their choices and allow more than one conversation if needed.
The final decisions remain with the person making the directive, provided they have decision-making capacity.
How My Evervale Can Support Care at Home
My Evervale provides practical home care based on each person’s current needs, preferences and agreed care arrangements.
Our team does not create, witness or interpret advance care directives and cannot provide medical or legal advice. These matters should be discussed with a doctor, qualified healthcare professional or lawyer where appropriate.
When a person has documented preferences relevant to their everyday support, families can share the appropriate information with My Evervale. Our team can consider those preferences when planning services within our role and work alongside the person’s family and healthcare professionals where required.
To discuss practical home care support for yourself or a family member, contact My Evervale today.