In this article, we examine Advanced Care Directives (ACDs) and
how they can be used to assist your loved ones to make decisions
about your medical treatment in circumstances where you lack the
capacity to make such decisions for yourself.
WHAT IS AN ACD?
An ACD is a document which sets out the types of medical
treatment that a person wishes to be administered or refused in
they are sick but expected to get better (or where their level
of functioning is acceptable to them); and
they are sick and not expected to get better (or where their
level of functioning is not acceptable to
Such treatment options include the use of blood transfusions,
methods of feeding, life sustaining measures such as CPR as well as
general levels of patient care (from an intensive level of care to
For example, an unacceptable level of care could be where a
person is so seriously ill or injured that the person would be
unlikely to recover to the extent that the person can live without
the use of life-sustaining measures. In such circumstances, an ACD
can be used to indicate that certain types of medical treatment are
to be refused.
WHO CAN MAKE AN ACD?
An ACD can be made by any person who is over 18 years of age and
who has capacity.
The case of Mr A
In the case of Hunter and New Area Health Service v A
 NSWSC 761, the defendant Mr A was a patient in a hospital
conducted by the plaintiff. Mr A developed renal failure as a
result of septic shock and respiratory failure and was being kept
alive by mechanical ventilation and kidney dialysis. The hospital
became aware of a document prepared by Mr A dated about 12months
prior to being hospitalised, indicating that he would refuse
dialysis treatment. The hospital commenced Court proceedings
seeking a declaration to the effect that the document referred to
was a valid ACD and that the hospital would be justified in
complying with the wishes Mr A expressed.
In considering the matter, the Court recognised two relevant but
in some cases, conflicting interests:
a competent adult's right of autonomy or
self-determination: the right to control his or her own body,
the interest of the State (ie the hospital and its doctors) in
protecting and preserving the lives and health of its
In determining the right of the hospital to withdraw dialysis,
the Court recognised a competent adult's right to autonomy, but
not a 'right to die'. It is important to recognise that an
ACD must not contain instructions for illegal activities such as
euthanasia or assisted suicide.
In this case the Court declared the ACD to be valid and
permitted the hospital to withdraw dialysis treatment. Had Mr A not
had a valid ACD, it is likely that treatment would have been
continued against his wishes.
WHAT ABOUT IN AN EMERGENCY?
Where it is not practicable for a medical practitioner to obtain
a patient's consent for treatment, and where that patient's
life is in danger if appropriate treatment is not given, then
treatment may be administered without consent.
However, where the patient has made an ACD specifying that he or
she does not wish to be so treated and there is no reasonable basis
for doubting the validity and applicability of the ACD, that ACD
must be followed.
HOW CAN I MAKE AN ACD?
An ACD should be in writing, signed and dated. Whilst there is
no mandatory form to use, we recommend consulting with an
experienced legal practitioner to prepare an ACD for you to ensure
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