What is an Advance Health Care Directive?
An advance Health Care Directive is a document that states your wishes or directions regarding your future health care for various medical conditions. It comes into effect only if you are unable to make your own decisions.
I have an Enduring Guardianship in place, do I still need an Advance Health Care Directive?
An Enduring Guardianship is the legal form of appointment of a substitute decision-maker in areas concerning your general health and lifestyle. An Advance Health Care Directive does not appoint a specific person to manage your health affairs, but provides a clear statement on your wishes and values that should be considered prior to medical treatment if you are unable to communicate these yourself at a later time.
What do I need to consider before making an Advance Health Care Directive?
You should think clearly about what you would want your medical treatment to achieve if you become ill. For example:
- If treatment could prolong your life, what level of quality of life would be acceptable to you?
- How important is it to you to be able to communicate with family and friends?
- How will you know what technology is available for use in certain conditions?
You are legally entitled to refuse medical treatment.
The purpose of an Advance Health Care Directive is to give you confidence that your wishes regarding health care will be carried out if you cannot speak for yourself. However, a request for euthanasia would not be followed as this would be in breach of the law. It is a criminal offence to accelerate the death of another person by act or omission. It is also an offence to assist another person to commit suicide.
Can I cover all possible health-care decisions in this form?
No, it would not be possible to anticipate everything, however the use of an Advance Health Care Directive in conjunction with the appointment of an Enduring Guardian can assist in covering more aspects of your health related decisions in the future. If you have an Enduring Guardianship in place already, it is recommended you discuss your health care wishes with them, and let them know if you have an Advance Health Care Directive in place so they can refer to it to ensure your wishes are carried out.
What should be included in my Advance Health Care Directive?
There is no prescribed form for an Advance Health Care Directive, it is generally a statement in writing of a person’s wishes in relation to future medical care, and in that sense, can take any form. It is suggested that an Advance Care Health Directive should state a person’s general preferences and values, as well as stating the person’s wishes in relation to specific treatment issues.
The direction must be specific enough to give clinical guidelines. It must not be vague eg “I direct my physician to forego artificial means and heroic measures” or “I do not wish to be a vegetable”. There may be problems understanding the exact meaning of these phrases.
On the other hand to state one’s wishes with medically specific directions also has its problems. The directive may specify whether or not a person wants ventilation, dialysis, tube feeding and so forth. The obvious problem here is that people making advance directives do not necessarily have the medical knowledge required to make those decisions. Nor can it be predicted with certainty what medical crisis may emerge and what appropriate treatment is needed. There is also the question of advances in medical treatment.
An example of a direction you may make:
If the time ever comes when I am unable to communicate or to recognize my family and there is no hope of my recovery, then I would consider that to be an unacceptable disability and I would want only palliative care.
It is recommended that you consider the levels of care which are acceptable. You may decide you wish to only receive palliative care, or specify the type of care that would be appropriate for you. You may also wish to address the issue of feeding, i.e. will you accept tube feeding, or tube feeding only in given circumstances, or only oral feeding. Also do you wish cardio-pulmonary resuscitation and personal care decisions made for you?
As with other documents such as your Will, Appointment of Enduring Guardian and Power of Attorney, an Advance Health Care Directive should be made by a legally competent person and be witnessed to validate its authenticity and ensure it is legally binding.
Can I change or revoke my Advance Health Care Directive?
Yes, your wishes as stated in an Advance Health Care Directive are not final, you can change them at any time while you remain mentally capable of doing so. It is wise to review your directive every two years, or if your health changes significantly.
If you do want to make changes to your directive, you should destroy the current one and make a new one. You may also totally revoke your directive at any time. This should be done in writing, so that you can give a copy to anyone who has a copy of your current Advance Health Care Directive.
Where can I get help with my Advance Health Care Directive?
Your doctor will be able to assist in explaining any medical terms or other words you may be unclear about. They can also assist you in gaining clarification of procedures, treatments and illnesses. You should also seek to discuss your wishes with your family and friends so they have a clear understanding about what is important to you in general terms about quality of life.
A solicitor can also assist you in better understanding an Advance Health Care Directive, its uses and limitations.
Examples of further clauses that may be included in an Advance Health Care Directive are available upon request. For more information and advice, please contact your solicitor.
