We often mention Appointment of Medical Treatment Decision Maker documents in our Estate Planning discussions. The Appointment of Medical Treatment Decision Maker (AMTDM) is the document under which you can appoint a person to make medical decisions on your behalf when you no longer have the capacity to make those decisions on your own.
An Advance Care Directive goes side by side with the AMTDM, the purpose of this document is to outline your wishes to your chosen medical decision maker. These wishes can include a variety of things, which include things such as:
- Whether you would like artificial feeding;
- Whether you wish to be connected to a ventilation machine;
- If you are nearing death, who you would like to be informed and who you would like for to be present.
Prior to the March 2018, an Advance Care Directive was not a binding document, so there was no real way for your loved ones to ensure your wishes were enforced. You could tell your medical decision maker what your wishes are, but a lot of people find peace in being able to write down their medical treatment wishes.
What can I include in an Advance Care Directive?
In an Advance Care Directive you can include:
- An instructional directive with legally binding instructions about future medical treatment you consent to or refuse; and/or
- A values directive which documents your values and preferences for your medical treatment decision maker to consider when making decisions for you.
Instructional Directive
An Instructional Directive should only be completed if you know exactly what you want, or don't want, in the future in respect to medical treatment.
An Instructional Directive is a statement of your medical treatment decision and takes effect as if you had consented to, or refused, the medical treatment.
The instructional directive will include things such as whether you agree to any of the following:
- Cardiopulmonary resuscitation;
- Assisted ventilation;
- Artificial hydration;
- Artificial nutrition; and/or
- Antibiotics.
Your answer may differ depending on the situation and whether you are:
- in the terminal phase of an incurable illness;
- permanently unconscious;
- in a persistent vegetative state; and or
- seriously ill or injured that you are unlikely to recover to the extent that you can live without the use of life-sustaining measures.
Health practitioners need your consent before providing medical treatment. However, an illness or injury may mean that you do not have decision making capacity to make the decision. In this instance, your health practitioner must make reasonable efforts to find out whether you made an Advance Care Directive with a relevant Instructional Directive. If you have, the directive will need to be followed by the health practitioner.
As lawyers we do not have an understanding of the medical side of things, and you might not have an in-depth understanding of what the options are. Therefore, we strongly recommend you sit down with your GP and discuss your wishes in relation to the above. Once you have identified your wishes we can then draw up the document for you and include your medical preferences.
Values Directive
A Values Directive is a statement of your values and preferences for your medical treatment. Some questions you might like to consider in determining your values include:
- What matters most in your life? For example:
- Do you want to live as long as possible, whatever it takes? Or is quality of life more important to you?
- Do you have religious or spiritual beliefs that affect the type of medical treatment you would consent to?
- What worries you most about the future?
- Are there other people that you would like involved? Consider if there are other people you would like your medical treatment decision maker and health practitioners to be involved in discussions with about your care.
If you are unsure about how to clarify your values, feel free to have a look www.myvalues.org.au, where you may complete a survey that will help you think more about the important issues that underpin difficult decisions.
Why should you consider a Values Directive?
If you do not have decision making capacity, your medical treatment decision maker will need to make the decision on your behalf. If you do not have an Instructional Directive, your medical treatment decision maker will need to make the decision they reasonably believe you would make. To do this, they may consider the following:
- Your values directive;
- Other values or preferences you have expressed.
An Advance Care Directive that includes both Values Directives and Instructional Directives is a great way to let your wishes be known and for your Medical Treatment Decision Maker to know exactly what you want. This will also mean they feel more comfortable in making decisions on your behalf knowing that they are what you want.
If you would like to put an Appointment of Medical Treatment Decision Maker and Advance Care Directive in place, please contact us.