Advanced Care Planning
1. What is it?
On Monday the 21st November 2022, the Guardianship and Administration Amendment (Advance Care Directives) Act 2021 commenced.
This change means that an Advance Care Directive has a legal basis and provides obligations under law for health practitioners to follow an advance care directive where reasonable.
You can find the new Advance Care Directive and Information Sheet on the Department of Healths Website HERE.
Advance Care Planning
Advancing illnesses or sudden events can sometimes mean that a person may lose the ability to make decisions about their health and personal care.
Advance Care Planning is a way that enables your patients to think about and discuss their personal values, wishes and beliefs along with their healthcare preferences and what matters most to them at the end of life if they lost the ability to communicate for themselves.
General practitioners along with practice nurses, play an integral role in promoting and facilitating advance care planning in general practice. They are able to support patients and their families through planning and discussing specific issues and provide information on the patient’s health, prognosis and future treatment options that may be available. These conversations are voluntary. Encouraging your patients to think about their values, beliefs and preferences regarding their current and future health care is important as it allows opportunity for discussion surrounding their attitudes, what’s important to them, how you can support them to live well and any acceptable outcomes regarding healthcare treatment options.
Regardless of age or health status, everyone should consider advance care planning, however, it becomes more important to discuss for those patients who are living with a life-limiting illness, have a new diagnosis such as cancer, have a cognitive impairment or are at risk of losing decision-making ability.
Planning ahead with your patients while they are well before there is an urgent need for a plan, will ensure they can receive the care they want, avoid unnecessary treatments, improve ongoing and end-of-life care for them and their family and avoid having to make difficult decisions under stressful circumstances.
It is important that these conversations are part of routine care and occur as part of a person’s ongoing healthcare plan. Your patients and their family are more likely to have better outcomes when advance care planning is introduced early as part of ongoing care rather than in reaction to a decline in condition or a crisis situation.
It is particularly important because the patient may later lose the ability to make decisions and not be able to participate in discussions when difficult decisions need to be made as the end of their life nears.
Substitute Decision Makers/Enduring Guardians
“Who would you like me to talk to if you were unable to talk to me about important medical treatment decisions? ”
You may also wish to discuss with your patients who might be a good person to act on your behalf and be your voice if you can no longer speak for yourself. In Tasmania, your patients may wish to formally appoint an enduring guardian. An Enduring guardian can make healthcare and place of care decisions for the person.
If your patient does not appoint an enduring guardian, the Guardianship and Administration Act (1995) has a hierarchy of people who would act as the person responsible. This may include a spouse, unpaid carer, adult child or someone who knows the patient well. A person responsible can only make health care decisions.
If the patient cannot make decisions for themselves, doctors must make every effort to find a substitute decision-maker or Person Responsible who can make decisions on the patient’s behalf.
Enduring guardians and persons responsible are also known as substitute decision-makers.
It will be important for your patients to think carefully about choosing a substitute decision-maker. You can find more information to assist you and your patients in this process on the Advance Care Planning Australia Website HERE.
For more information and for relevant forms about appointing an enduring guardian or other matters relating to guardianship, administration, enduring powers of attorney, emergency situations, statutory wills, consent and other decision-making abilities, please visit the Tasmanian Civil and Administrative Tribunal (TASCAT) HERE.
The Tasmanian Advance Care Directive
After discussing advance care planning with your patients, you can encourage them to document their plan on the Tasmanian Advance Care Directive (ACD). This is a legal document that records your specific preferences for future health care.
Every adult who has the decision-making ability to make their own decisions has the right to agree to or refuse medical treatment, and the ACD is a way of providing this information to other people if the person can no longer make decisions for themselves. People who are under 18 can make a legal Advance Care Directive if a healthcare practitioner is satisfied that they are sufficiently mature and they meet the other requirements for decision making ability.
By completing these documents is the best way for people to make their preferences known about the type of treatment they would want if they are unable to participate in decisions and to inform health professionals of these preferences.
Encourage patients to share copies of the documents with you and their:
- Substitute decision-maker
- GP, treating doctor or other medical professionals involved in their care
- Local hospital
- Upload a copy to My Health Record
Review regularly or as needed as preferences/goals may change over time
There is now the option to register Advance Care Directive’s through Tasmanian Civil and Administrative Tribunal (TASCAT) Details HERE.
This is a new process. Their contents initially will be available during business hours to health practitioners, emergency services, RACFs and authorised decision makers.
Registration will be free.