Everyone knows my life choices so why do I need an Advance Care Directive?
When someone suggests you should have an Advance Care Directive, a pretty common response is to avoid that conversation as it can challenge you to think about life – and the end of it.
So let’s break down how an Advance Care Directive (“ACD”) works and why it’s good for you and your loved ones.
Firstly – everyone?With no formal ACD, people (for example, doctors and other medical providers) looking for decisions will (and may need to) speak to the most accessible person who is authorised by law to make that decision.
In medical situations government legislation sets out who can provide relevant consent and direction. That legislation sets out a descending order of priority:
- At the top is a person (or persons) who have been appointed under a formal ACD;
- At the lower end is a director of nursing at an aged care facility; and
- In the middle are various family members of varying levels of ‘kinship’ to you but who have no formal/legal documentation to enable them to make decisions on your behalf.
What happens if I don’t have an Advance Care Directive?
Would everyone on the list know what you want? And would they convey your wishes in the same way or in the way you wished?
In other situations (non-medical), such as where you should live, there is simply no legislation authorising someone to make that kind of decision. Ultimately, South Australian Civil and Administrative Tribunal (formerly the Guardianship Board) will be approached to appointment an appropriate person or persons, (which could also be the Public Advocate) to carry out those decisions.
Of course, you may have had the same, or similar discussions about your wishes with all family members but over time people might interpret discussions with you in different ways and tensions may arise between them as to who knows those wishes best.
The other factor of course is the extent to which you might have provided guidance across the range of issues which might arise. For example, ‘don’t resuscitate me’ or ‘pull the plug’ are clear, but what about where you might live and what your priorities might be for living (as opposed to dying) if your life is affected by dementia for an extended period?
What will an Advance Care Directive do for me?
A formal written ACD ensures everyone has the same guidance and the ACD can specifically appoint a person (or persons) who are authorised by you (not by government legislation) to convey your wishes to those who need to know.
Further, family members are well known to come at the same issue with good intentions but with vastly different perspectives. These are often discovered at the most difficult of times.
Consider this example:
If you lose mental capacity but retain good physical health then consideration needs to be given to matters such as things you might like to do and/or experience and, often most importantly, where you might live and who might care for you on a day-to-day basis.
If your needs were such that nursing care was necessary then how and where that care is delivered would become critical. If, in an ACD, you stated your willingness to enter a nursing home then plainly, the agony of a family thinking they had, out of necessity, ‘abandoned you in a nursing home’ would evaporate. Your statement in an ACD would in essence, be a gift to those making difficult choices for your wellbeing and would likely prevent argument over ‘what Mum/Dad would want or tolerate’.
In short, it would be a comfort to those making decisions to have certainty as to your wishes, both by seeing them in writing and by knowing that they are the person (or persons) you have specifically appointed to put them into action. The more thought and written guidance you give in your ACD, the more comfort and confidence you provide; a thoughtful gift to those who may be called on to make difficult decisions
So, to summarise
A written formal Advance Care Directive will give certainty to all (that is, it/you will make sure ‘everyone knows what you want’) and will give specific authority and comfort to those you appoint as substitute decision makers.
So, should you have an ACD?
Let’s say it’s way better than working on an over-confident assumption and leaving those you care about to agonise, and in so doing, potentially argue at a difficult time.
Maybe it’s better to say, “everyone knows what I want because I have an ACD”!
You can complete an Advance Care Directive online with acdAssist
acdAssist is a guided question and answer process, that you can complete at your own speed and in your own words. It is designed to identify your wishes and needs to those who you choose to make decisions for your care when you are no longer able to make those decisions yourself. These are then included in an Advance Care Directive for you to sign.