Advance Health Directive / Advance Care Directive (Australia)

An Advance Health Directive / Advance Care Directive in Australia records a person's wishes about future medical treatment and care for use if they later lose capacity to decide for themselves, recognised under state and territory advance care directive and guardianship legislation.

In Australia, the legal framework for advance directives is governed by different legislation in each state and territory. The most thorough legislation is found in South Australia (Advance Care Directives Act 2013 SA), Victoria (Medical Treatment Planning and Decisions Act 2016 VIC), and Queensland (Advance Health Directive provisions under the Powers of Attorney Act 1998 QLD). In New South Wales, there is no single thorough statute, but advance directives are given effect under common law and the Guardianship Act 1987 NSW. The Australian Capital Territory has the Medical Treatment (Health Directions) Act 2006 ACT; Western Australia uses the Guardianship and Administration Act 1990 WA; Tasmania uses the Guardianship and Administration Act 1995 TAS; and the Northern Territory relies primarily on common law supplemented by the Natural Death Act 1988 NT.

An Advance Health Directive serves several distinct functions. First, it records specific treatment directions — what medical interventions you do or do not consent to in defined clinical circumstances. These directions are legally binding on healthcare providers in states with specific legislation, and given strong effect under common law in other states. Second, it records your values and beliefs — what quality of life means to you, what conditions you would or would not find bearable, and what matters most to you in making medical decisions. These value statements guide interpretation of your specific directions and assist your substitute decision-maker in situations not expressly addressed. Third, it may nominate a substitute decision-maker — a person authorised to make healthcare decisions on your behalf when you lack capacity, consistently with your expressed wishes.

The most common specific directions include: Do Not Attempt Resuscitation (DNAR) or Do Not Attempt Cardiopulmonary Resuscitation (DNACPR), which instructs healthcare providers not to attempt CPR if the heart stops; directions about mechanical ventilation (whether to be placed on a breathing machine); directions about artificial nutrition and hydration (tube feeding); and comfort-focused or palliative care only directives, which instruct healthcare providers to focus on managing pain and distress rather than attempting to prolong life.

The legal framework governing the Advance Health Directive / Advance Care Directive (Australia) in Australia draws on several key statutes and regulatory bodies. Under state succession legislation — including the Succession Act 2006 (NSW), Wills Act 1997 (Vic), and Succession Act 1981 (Qld) — the Supreme Court of each state administers probate. The Trustee Act 1925 (NSW) and equivalent state Acts govern trustee obligations. The Australian Taxation Office (ATO) administers estate taxation. Section 7 of the Succession Act 2006 (NSW) sets formal requirements for valid wills. The Privacy Act 1988 (Cth) applies to personal data held by executors and administrators. Parties executing a Advance Health Directive / Advance Care Directive (Australia) in Australia should confirm the document reflects current law, including any amendments enacted since the original drafting date. The applicable state Advance Care Directive and Guardianship Acts set the foundational requirements.

An Advance Health Directive is relevant for every Australian adult, not just older people or those with serious illness. Accidents, sudden strokes, traumatic brain injuries, or rapidly progressing illness can leave any person unable to communicate their wishes at any age — and without an advance directive, healthcare providers and families must make difficult decisions in the absence of clear guidance from the patient.

The following situations make an Advance Health Directive particularly important. Older adults and those approaching end of life who want to confirm that their wishes about the extent and nature of medical treatment — including whether to receive CPR, ventilation, or hospitalisation — are clearly documented and respected by their treating teams and family. A clear advance directive avoids family conflict at what is already an emotionally difficult time.

People diagnosed with progressive or terminal conditions such as cancer, motor neurone disease, dementia, heart failure, or chronic obstructive pulmonary disease should prepare an advance directive early in the course of their illness, while they retain full capacity, so that their wishes are documented before capacity is compromised by the disease itself.

People with strong values about quality of life — including those who, for religious, cultural, or personal reasons, hold clear views about the extent to which they wish medical technology to prolong life — should document those views in an advance directive so that healthcare providers cannot act contrary to them.

Family members who have witnessed a loved one's experience of prolonged, unwanted, or undignified medical intervention at the end of life often report that preparing their own advance directive is a priority following that experience. This is a common motivation for completing an advance directive while in good health.

Any adult who is planning a surgical procedure or entering hospital should have an advance directive in place, because an unexpected complication may result in sudden incapacity. Reviewing and updating your advance directive at each stage of life — ideally with your GP as part of advance care planning — confirms that it remains current and accessible.

A thorough Australian Advance Health Directive should address the following key elements.

A values and beliefs statement is the foundation of the document. It describes what quality of life means to the person making the directive, what conditions or states they would or would not find acceptable, and what spiritual, religious, or cultural beliefs should guide medical decisions. This statement is essential for interpreting specific directions and for guiding the substitute decision-maker in unforeseen circumstances.

Specific treatment directions address defined clinical circumstances — typically: terminal condition (dying, even with treatment); permanent unconsciousness or vegetative state; and advanced dementia or severe cognitive impairment. For each circumstance, the directive should state whether the person consents to life-sustaining treatment, requests comfort care only, or delegates the decision to their substitute decision-maker.

CPR and resuscitation preferences are one of the most practically important elements. A direction not to attempt CPR (DNACPR) must be clearly stated if that is the person's wish, and should be communicated to the treating GP for a corresponding clinical DNACPR order to be put in place.

Artificial nutrition and hydration directions address whether tube feeding or IV fluids should be provided if the person is unable to eat or drink. Many people who wish to avoid prolonged dying are surprised to learn that artificial hydration can extend the dying process — the directive should address this explicitly.

Mechanical ventilation directions address whether the person wishes to be placed on a breathing machine and, if so, whether they consent to a time-limited trial only.

Palliative and comfort care statements describe the person's wishes about where they wish to die, what their pain management priorities are, and what quality-of-life factors matter most to them.

Organ and tissue donation preferences should be consistent with the person's registration on the Australian Organ Donor Register (donatelife.gov.au).

The substitute decision-maker nomination identifies the person authorised to make healthcare decisions when the directive alone does not resolve the clinical situation, and should be consistent with any separate formal appointment document required by the applicable state legislation.

An authorised witness certification is required in all Australian states for a legally effective advance directive. The witness must certify that the person had capacity and was acting voluntarily. Two witnesses are required in most states, with at least one being an authorised witness (solicitor, registered medical practitioner, or justice of the peace).

Additional compliance elements for a Advance Health Directive / Advance Care Directive (Australia) used in Australia include: Under state succession legislation — including the Succession Act 2006 (NSW), Wills Act 1997 (Vic), and Succession Act 1981 (Qld) — the Supreme Court of each state administers probate. The Trustee Act 1925 (NSW) and equivalent state Acts govern trustee obligations. The Australian Taxation Office (ATO) administers estate taxation. Section 7 of the Succession Act 2006 (NSW) sets formal requirements for valid wills. The Privacy Act 1988 (Cth) applies to personal data held by executors and administrators. Forms-legal.com provides this template as a starting point for Australia-compliant documentation.