Advance Health Directives

You decide what decisions and treatments you want to include in the Advance Health Directive. You can include medical, surgical and dental treatments, palliative care and measures such as life-support and resuscitation. It is helpful to be as specific as possible in your treatment decisions.

The form also includes a values and preferences section where you can write down things that are most important to you about your health and care. The questions in this section are the same as those in the Values and Preferences Form (PDF 281KB).

The WA Advance Health Directive was updated in the Guardianship and Administration Act Regulations on 4 August 2022. The new Advance Health Directive is easier to complete and understand as it:

• enables you to capture your values and preferences, in addition to treatment decisions
• includes more guidance and examples
• combines tick box and free text questions
• includes consent to medical research.

Statutory documents are the strongest and most formal way of recording your values, preferences and decisions for future health and personal care. Examples include an Advance Health Directive and an Enduring Power of Guardianship.

These documents are recognised under legislation in WA and, in most situations, must be followed.

Statutory documents must:

• be made by an adult with capacity
• be made by the person (not by someone else on their behalf)
• be signed by the person and witnessed according to formal requirements.

Yes. In most situations, if you become unable to make or communicate decisions about your treatment and care, health professionals must follow the decisions in your Advance Health Directive, except in some limited exceptions. A limited exception may occur if:

• circumstances relevant to your treatment decision have changed since you made the treatment decision, and
• you could not have reasonably anticipated those changes when you made your Advance Health Directive, and
• it is likely that a reasonable person with knowledge of the change of circumstances would change their mind about the treatment decision.

If you are unable to make decisions for yourself and non-urgent treatment is needed, treatment decisions will be made according to the Hierarchy of treatment decision-makers (PDF 1.5MB).

If you do not have an Advance Health Directive, or your Advance Health Directive does not cover the treatment decision required, the health professional will seek a treatment decision from the first person on the hierarchy who:

• is 18 years or older
• has full legal capacity
• is reasonably available
• is willing to make the decision.

Doctors and other health professionals are obliged to respect the directive, be it an Advance Health Directive or one given by an Enduring Guardian on behalf of the patient. It is important to remember that it is not only doctors who are bound by this legislation. The law applies to all health professionals that are caring for a patient.

For example, a person who is at a terminal stage of their illness and who lives in a care facility e.g. a nursing home with which they are familiar, can decide that they don’t want to die in a hospital. Instead, they may just wish to be kept comfortable in their current nursing home. If they indicate this in their Directive, the care facility is bound to respect it.

How will they know that someone has written an Advance Health Directive?

Healthcare professionals cannot honour something that they do not know exists. It is the responsibility of the patient to make sure that everyone who may be involved in their care is aware that they have written an Advance Health Directive or appointed an Enduring Guardian or both.

We suggest that they give copies to their general practitioners, other doctors looking after them, the hostel or nursing home if they are in one, their family members and so on. They may wish to carry a card in their wallet to indicate that they have an Advance Health Directive and where to find it. If they have an Enduring Guardian, they may wish to have this information and the contact details of the guardian in their wallet. They may also wish to have a MedicAlert bracelet to indicate this.

Likewise, if a person revokes their Advance Health Directive or updates it, it is the person’s responsibility to let everyone who needs to know, know this.

It can be difficult to write an Advance Health Directive in any language but it is suggested that if you want the health care professional to respect your wishes, you have to make it easy for them to do so. And, at present, that means that your directions need to be clear and therefore in English.

Imagine the situation where you were in an emergency situation and your Advance Health Directive is written in a language other than English. It is not possible to respect an Advance Health Directive if one doesn’t know whether the Directive gives orders for a particular emergency situation and if so, what those orders may be. Although in an ideal world, a translation could be obtained quickly, we need to anticipate that this may not happen.

Sometimes, you have to make it easy for people to do what you wish them to do. That means making the Advance Health Directive easy to understand. The Office of the Public Advocate provides advice as to what a patient may do in this situation e.g. get the Advance Health Directive translated in advance.

Certainly, people are encouraged to review their Advance Health Directive whenever their condition or situation changes or every 2-5 years. Just remember, that if you do update your Advance Health Directive, you must let everyone who is involved in your care know about the changes.