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Making an Advance Directive for Health Care in South Australia
under the Consent to Medical Treatment and Palliative Care Act 1995 or Guardianship and Administration Act 1993
Advance Directive is a general term used to describe legal documents containing instructions to take effect some time in the future. An Advance Directive for Health Care, sometimes referred to as a Living Will or Anticipatory Direction, is a written statement of health care you want should you be unable to make decisions about your medical treatment.
SAVES is fully and actively supportive of health care advance directives. We all have a responsibility to set out our wishes for health care in the future against the possibility that we may be unable to communicate those wishes at the time. This situation may arise through accident or illness, and those caring for us may find themselves uncertain about what medical treatment we would wish. If this is not recorded they will have to decide as best they can. They may find the uncertainty and responsibility distressing. In any event, setting out our wishes will increase our chances of receiving the treatment we want. It is also advisable to let your family and friends know of your advance directive so that any possible source of conflict is addressed. We should be aware that in the absence of any advance directive or medical power of attorney (see below), a medical practitioner may be put in the position of carrying out treatment without knowing the patient's wishes.
There are two ways of completing an advance directive for healthcare in SA. These are under the Consent to Medical Treatment and Palliative Care Act 1995 and the Guardianship and Administration Act 1993.
South Australia's Consent to Medical Treatment and Palliative Care Act 1995 makes provision for two types of advance directive:
- an Anticipatory Direction and
- a Medical Power of Attorney which appoints a Medical Agent or Agents to make medical decisions on your behalf in accordance with your written instructions
Either or both directives may be used.
The Anticipatory Direction operates only when a person enters the terminal stage of a terminal illness or a persistent vegetative state, and becomes incapable of making decisions about medical treatment. The Medical Power of Attorney is less restricted. A Medical Agent can act at any time of mental incapacity, not only in the terminal stage of a terminal illness or a persistent vegetative state. Appointing a Medical Agent can increase your chances of having your wishes respected, and help if uncertainties about your treatment arise.
South Australia's Guardianship and Administration Act 1993 makes provision for the appointment of an Enduring Guardian or Guardians to make a range of medical, personal and lifestyle decisions on your behalf should you become temporarily or permanently unable to give informed consent for any reason. This advance directive can take effect at any time of mental incapacity.
The Consent to Medical Treatment and Palliative Care Act Schedules and explanatory information can be obtained from Service SA, 101 Grenfell St Adelaide, Tel 132324, or downloaded from the website of the SA Department of Health (www.dh.sa.gov.au/consent) which includes a link to the website of the Office of the Public Advocate www.opa.sa.gov.au for information on appointing an Enduring Guardian under the Guardianship and Administration Act. An Enduring Power of Guardianship kit may be purchased over the counter at Service SA or by telephone and credit card. For further inquiries contact the Guardianship Board freecall on 1800 800 501. Information and advice is also available from the Office of the Public Advocate, freecall on 1800 066 969. A lawyer is not needed to complete an advance directive. However, in some circumstances, eg if your family situation is complicated, you may wish to consult one.
Advance Directives do not allow for a quick and peaceful death by voluntary euthanasia, but for the refusal of further medical treatment, or the withdrawal of medical treatment including life support systems. There must be no intention to hasten death. The dying process may therefore extend over a lengthy period.
It has been claimed that Advance Directives are at times ignored. It is potentially a criminal offence to disregard an Advance Directive and any suspicion that this may be happening or may have happened should be reported to the Dept Health Research Policy / Ethics Unit on 8463.6145. Keep in mind, however, that an Advance Directive is only part of a process of communication that involves the patient, the health care team and others with an interest in the welfare of the patient. As Advance Directives become better known, and patients and the health care profession become better equipped for their use, their effectiveness will increase. Advance Directives, simple in concept, can be complex in practice. Despite the possibility of complications, they provide your best chance of having your wishes known and respected should you be unable to speak for yourself. We are fortunate in South Australia that some of the ambiguity surrounding medical care has been removed by enlightened legislation. We may expect that the prohibition of voluntary euthanasia will be removed eventually and that later it will be permissible to include a request for euthanasia in an Advance Directive.
Life Values Statement
No matter how careful you may be in setting out your wishes, it is possible that something unforeseen will arise which will create uncertainty. SAVES has prepared a two page form that may help in this situation. It allows you to indicate your wishes on a 5 point scale for 6 specific life situations. It also allows you to request voluntary euthanasia should it become legal after you have lost competence. Although the Life Values Statement does not have legal status, it could influence decisions in unusual situations. Life Values Statement (PDF 21kb)
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