Advance care directives explained: putting your health wishes in writing

If you became too unwell to speak for yourself, would the people treating you know what you would want? An advance care directive is how you answer that question in advance, in writing, while you still can. It is one of the most useful, and most overlooked, documents in planning for later life.

The short version: an advance care directive is a document that records your preferences for future health care, including the treatments you would or would not want, and your values about what a good quality of life means to you. In most states it can also let you appoint someone to make health decisions for you if you lose the capacity to make them yourself. It only ever applies to health and personal matters, and only when you can no longer decide for yourself.

What an advance care directive is

An advance care directive is the written, formal part of advance care planning, the broader process of thinking and talking about the care you would want if you were seriously ill or near the end of life. The plan is the conversation; the directive is the document that makes your wishes clear and, in most cases, legally recognised.

A directive typically covers two things: your instructions and preferences about medical treatment (for example, whether you would want life-prolonging treatment in particular circumstances), and the values, beliefs and goals that should guide decisions the document does not spell out. Some people also use it to note practical and personal wishes, such as where they would prefer to be cared for.

How it differs from an enduring power of attorney

This is where people get tangled, so it is worth being clear.

An enduring power of attorney, broadly speaking, is about appointing a person to make decisions for you, most commonly financial and legal ones, and in some states personal or medical ones too.

An advance care directive is about your health wishes: what you want to happen, not only who decides. In most states and territories it can also appoint a substitute decision-maker for health specifically, but its distinctive job is recording your instructions and values so that whoever is deciding, whether that is your appointed person or your treating team, knows what you would have chosen.

In practice the two work together. Many people have both: a power of attorney handling money and legal affairs, and an advance care directive guiding health and end-of-life care. Neither replaces the other.

The rules differ by state and territory

Advance care directives are governed by state and territory law, so the name, the form and exactly what the document can do all vary depending on where you live.

• In most states the document is called an advance care directive. In Queensland and Western Australia it is called an advance health directive.
• Most states and territories have specific legislation setting up a statutory directive with an official form. New South Wales is the main exception: it relies on common-law directives, which are still legally binding when validly made, rather than a single statutory form.
• In the Northern Territory, advance care wishes are recorded through an Advance Personal Plan, which can combine health and financial planning in one document.
• The rules for who can be appointed as a health substitute decision-maker, and what they are called, also differ between states.

Because of this variation, the single most reliable step is to use the correct, current form for your own state or territory. Advance Care Planning Australia runs a free National Advance Care Planning Support Service on 1300 208 582 and publishes the right forms and guidance for each state, which is the best place to start.

Why it matters, especially in later life

Without a directive, if you lose capacity, decisions fall to a substitute decision-maker (often a family member) and your treating team, who must try to work out what you would have wanted, sometimes under pressure and without clear guidance. That can lead to treatment you would not have chosen, and it can leave families carrying the weight of guessing, and second-guessing, at an already painful time.

A clear directive spares your family that burden and makes it far more likely your wishes are followed. It sits naturally alongside broader planning: it pairs with palliative care when someone is living with a serious illness, and with the practical steps families take when arranging aged care.

How to make one

The details vary by state, but the shape is consistent:

1. Think and talk. Reflect on what matters to you about your health and quality of life, and discuss it with the people close to you and, ideally, your doctor. The conversation is the most important part.
2. Get the right form for your state or territory. Advance Care Planning Australia (1300 208 582) can point you to it, as can your state health department.
3. Complete it, with medical input where needed. A GP can help make sure your instructions are clear and clinically meaningful. Some states require specific witnessing.
4. Appoint a substitute decision-maker if your state allows it in the directive, choosing someone who understands your wishes and will speak up for them.
5. Share it. Give copies to your substitute decision-maker, family, GP and hospital, and keep it somewhere accessible. A directive nobody can find when it is needed does not help.
6. Review it after any major change in your health or circumstances. You can update it while you still have capacity.

Frequently asked questions

What is the difference between an advance care directive and an enduring power of attorney?

An enduring power of attorney mainly appoints someone to make decisions for you, often financial and legal ones. An advance care directive records your health care wishes and values, and in most states can also appoint a health decision-maker. They cover different ground and many people have both.

Is an advance care directive legally binding?

A valid directive must generally be followed by health professionals. Most states and territories have legislation giving statutory directives legal force; New South Wales recognises common-law directives instead. The safest approach is to use the correct current form for your state so it is valid where you live.

Does an advance care directive cover my money or my will?

No. It only covers health and personal care decisions, and only while you are alive but unable to decide for yourself. Money and legal matters are handled by an enduring power of attorney, and what happens after death is handled by your will.

Can I change my advance care directive later?

Yes, at any time while you still have decision-making capacity. Complete a new one, tell your substitute decision-maker and family, and replace the old copies you have shared so nobody relies on out-of-date wishes.

Do I need a lawyer to make one?

Not necessarily. Many people complete their state's form with help from their GP and family. Legal advice is worth getting if your situation is complex, or if you want the directive to work smoothly alongside an enduring power of attorney and your will.

This is general information, not legal or medical advice; advance care directive laws differ by state, so use your state or territory's current form and speak with your doctor, or Advance Care Planning Australia on 1300 208 582, for guidance.