Your Advance Care Directive (ACD) is valid from the date when all of your Substitute Decision Makers (SDMs) have accepted their appointment and you have also signed the form and had your signature correctly witnessed.

I have a valid ACD. When can my SDMs begin to use it?

Before your SDMs begin to use your ACD, your doctor will assess if your ACD is valid and whether or not it is applicable to your current treatment.

Your SDMs will only be able to use your ACD when you no longer have decision making capacity.

Losing your capacity means that you are unable to make your own health and lifestyle decisions either temporarily or permanently. For example, you may temporarily be unable to make decisions if you have early signs of dementia or are in a coma or have an acute illness and your ACD will operate during these specific time periods only.

If you are unable to make decisions for yourself and that situation is permanent then your ACD will operate permanently.

You are presumed to be competent to make decisions for yourself unless there is good reason to think otherwise.

When can I not make decisions for myself?

You will be incapable of making decisions for yourself if you cannot:

• understand information relevant to the decision or its consequences;
• retain information even for short periods;
• use information to make decisions;
• communicate what your decision is.

In these situations, your SDMs can make decisions for you.

The difficulties with fluctuating capacity

You might find that in the morning you are able to clearly understand things but in the afternoon it becomes very difficult or impossible. This can present a challenge to those assessing you, as your ACD only becomes active once you have lost capacity. This means that your SDM might only be able to make decisions for you at a particular time of day when you do not have capacity.

You are not considered incapable of making your own decisions if you can only retain information for short periods of time.

If your SDMs are unclear whether or not you have capacity to make your own decisions, they should arrange for a capacity assessment to be completed by your doctor.

You will be assessed at the time of making the decision (prior to any treatment being administered), not in the hours or days before, as your capacity can fluctuate.

If you do not understand in general terms what the treatment or procedure required is and why it is required and the consequences of not having treatment, then you may not be able to make decisions for yourself and your doctor will consider that your ACD applies. In these circumstances they will contact your SDMs who should follow the wishes set out in your ACD.

Looking for more advice about your ACD?

You can contact a lawyer who specialises in these types of documents. Visit the acdAssist “Who can help you” page.

Looking to write an ACD?

You can use the acdAssist online platform to write your Advance Care Directive. The online assistant will guide you through what is required and once you’ve completed your instructions, you can arrange to have your ACD signed.

Start your Advance Care Directive online now.acdAssist

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.