Advance Directive (New Zealand)

An Advance Directive in New Zealand records a person's wishes about future medical treatment and care for use if they later lose capacity to decide for themselves, recognised under Right 7 of the Code of Health and Disability Services Consumers' Rights 1996.

Right 7(7) of the Code of Rights affirms every consumer's right to refuse services (including life-sustaining treatment) and states that a consumer's informed refusal must be respected, even if it may result in the consumer's death. This provides the legal foundation for Advance Directives in New Zealand. The Protection of Personal and Property Rights Act 1988 (PPPR Act) also provides relevant context, particularly in relation to the role of a Personal Care and Welfare Attorney appointed under an Enduring Power of Attorney, who must respect a valid Advance Directive.

An Advance Directive typically covers instructions about: cardiopulmonary resuscitation (CPR) and DNAR (Do Not Attempt Resuscitation) orders; mechanical ventilation and breathing support; artificial nutrition and hydration; dialysis for kidney failure; palliative care and pain management preferences; preferences for specific care settings (home, hospice, hospital); and personal, cultural, and spiritual wishes including tikanga Māori protocols for Māori people.

New Zealand's End of Life Choice Act 2019 (EOLCA) introduced a separate process for assisted dying for eligible people with a terminal illness — this is distinct from the refusal of treatment documented in an Advance Directive. An Advance Directive cannot be used to request assisted dying under the EOLCA, which requires a contemporaneous, competent request.

Advance Care Planning New Zealand (part of Te Whatu Ora — Health New Zealand) actively promotes advance care planning and provides resources to help New Zealanders document and share their wishes with health providers. The national ACP document complements a formal legal Advance Directive and can be held in electronic health records.

Every adult New Zealand resident should consider creating an Advance Directive, but there are specific circumstances where doing so becomes especially important and time-sensitive.

If you have been diagnosed with a serious or progressive illness — such as cancer, heart disease, chronic obstructive pulmonary disease, renal failure, motor neurone disease, Alzheimer's disease, or Parkinson's disease — creating an Advance Directive while you still have full capacity is a critical step in your medical planning. Similarly, if you are about to undergo major surgery or medical procedures that carry a risk of complications affecting consciousness or capacity, an Advance Directive confirms your wishes are on record.

For older New Zealanders, advance care planning is a routine part of good health care. Te Whatu Ora and district health boards encourage all people over 75, and younger people with significant health conditions, to complete advance care planning documents and have conversations with their GP and family about their wishes.

An Advance Directive is particularly valuable for people who have strong views about the type of care they want or do not want at the end of life; those who wish to avoid aggressive life-prolonging interventions; those who want to confirm cultural and spiritual wishes are respected (including tangihanga and other Māori cultural protocols); and those who do not wish their family to have to make difficult medical decisions on their behalf without guidance.

You should review and update your Advance Directive after any significant change in your health or circumstances, and at least every five years, to confirm it continues to reflect your current wishes and values.

A thorough New Zealand Advance Directive should include several important elements to be effective.

A Declaration of Capacity affirms that you were competent and fully informed when you made the directive, which is essential to its legal validity under the Code of Rights 1996. This declaration helps protect the document against challenges based on claims of incapacity at the time of signing.

A Values and Goals Statement goes beyond specific medical instructions to describe what gives your life meaning and your overall priorities for care. This context guides clinical decision-making in situations that your specific instructions may not anticipate, helping health providers and family act in alignment with your values.

Treatment-Specific Instructions address each common intervention separately: CPR, mechanical ventilation, artificial nutrition and hydration, dialysis, and other life-sustaining treatments. Each instruction should be clearly expressed as either a refusal, a consent, or a direction to exercise clinical judgement.

Condition-Specific Instructions address common end-of-life scenarios such as terminal illness, permanent unconsciousness (Persistent Vegetative State), and advanced dementia. These instructions allow you to tailor your wishes to different clinical situations, which increases precision and reduces ambiguity for treating clinicians.

Palliative Care Preferences specify your wishes for pain and symptom management, including whether you consent to palliative sedation, and your preference for care setting (home, hospice, hospital).

Cultural and Spiritual Wishes are especially important for Māori, Pacific, and other cultural communities with specific protocols around illness, death, and the care of a body after death. Including tikanga Māori requirements or other cultural preferences confirms these are honoured.

A Signature Block with recommended witnesses strengthens the document's credibility. While witnesses are not legally required for a New Zealand Advance Directive, having two independent witnesses sign and date the document provides strong evidence of your capacity and voluntary intent at the time of signing. The forms-legal.com Advance Directive (New Zealand) provides a ready-to-use template that meets New Zealand legal requirements.