Advance Care Planning

What is advance care planning?

Advance care planning is a process of planning for future health care and personal care where a person's values, beliefs and preferences are made known so they can guide decision making at a time when that person cannot make or communicate their own decisions due to a lack of capacity.

A patient's preferences need to be accessible by practitioners at all points of care for informed decision-making to occur.

Changes to medical decision-making laws in Victoria

The Medical Treatment Planning and Decisions Act 2016 came into effect on 12 March 2018. It provides a framework for medical treatment decision making for people who do not have the capacity to make their own decisions. It also includes significant changes for health practitioners and for the community. The Act also gives people greater opportunity to make decisions for future medical conditions where previously this could only be done for current conditions.

From this date, an Advance Care Directive is the formal document recognised by legislation that comes into effect if a person loses capacity (cannot make or communicate their own decisions). The directive allows refusal or withdrawal of medical treatment and consent to commencement of future treatments. The directive allows for binding instructional and/or values directives.

Prior to this date a Refusal of Treatment Certificate was the formal document recognised by legislation. A Refusal of Treatment Certificate remains binding from 12 March 2018 if there is no Advance Care Directive.

Health practitioners must give effect to any instructional directive in an advance care directive unless:

Circumstances have changed since the person gave the advance care directive so that the practical effect of the instructional directive would no longer be consistent with the person's preferences and values
The delay that would be caused by an application to VCAT as to whether the directive is applicable would result in a significant deterioration of the person's condition.

Health care professionals must comply with a Refusal of Treatment Certificate If the person who gave the Refusal of Treatment Certificate no longer suffers from the "current condition" then the Refusal of Treatment Certificate will not apply.

For more information see:

Who should be involved in advance care planning?

The healthcare system is complex and everyone has a role to play working together to ensure patients are at the centre.

Advance care planning is about relationships between individuals, their families and carers, health professionals, community organisations and healthcare organisations. Each group has its own roles and responsibilities to ensure that patients' healthcare preferences are respected.

There are roles to be played in advance care planning by:

General practice: Doctors and staff within general practice clinics can play a role throughout the advance care planning process, from introducing the topic to activating plans at the end of a person's life.

Hospitals: Hospitals have a key role in identifying whether any prior planning has occurred - whether the patient has appointed a Medical Treatment Decision Maker or completed an Advance Care Directive (ACD). Hospitals also have a role in activating or enacting someone's ACD. In an acute health crisis, knowing a person's values and preferences helps clinicians provide appropriate care.

Community nursing services: Community nursing services provide care to patients in their own homes for a variety of reasons, from episodic care through to end-of-life care. They can play a role in raising advance care planning awareness among patients, ensuring patient preferences are documented in records and, depending on their role, have conversations about advance care planning or refer patients to another health professional for this discussion. Community nurses also have a role in using Advance Care Directives to guide their decision making.

Community health services: Community health services in Victoria provide a range of services to different client groups, including older people, those with complex care needs and people from diverse backgrounds. The wide range of health and social care professionals in this sector have a key role in promoting advance care planning with their clients.

Residential aged care: Residential aged care staff play a key role supporting residents and their families with advance care planning. Often these staff are the primary contact for residents, families, general practice, hospitals and others involved in the resident's care.

Medical deputising (locum) services: Medical deputising (locum) services provide care to people when their own GP is not available in the after hours period. This includes visiting people in their homes or residential aged care facilities. Their main role in advance care planning is to receive, interpret and enact Advance Care Directives where appropriate.

Read more about the roles and responsibilities for each here.

Legal requirements for advance care planning

Making one's own healthcare choices is a right in Australia, but legal requirements differ between states and territories.