Advance care planning and voluntary assisted dying

An advanced care plan is an important way to ensure future health care wishes are respected. So why can’t I include voluntary assisted dying?

National Advance Care Planning Week (20-26 March) is an opportunity to start a conversation with your loved ones about your future health needs. The more conversations you have, the more confident your loved ones will be to make the right decisions on your behalf. But not all medical wishes can be included in advance care planning documents. Why?

What is advance care planning?

If you became seriously ill and were unable to speak for yourself, who would speak for you? What treatment would you receive? During the advance care planning process, you can prepare for your future by talking about your beliefs, values, and treatment preferences. This helps your doctors and loved ones understand what is most important to you and make decisions about your care when you can’t. Crucially, it provides you with a sense of control and offers peace of mind.

Ideally, at the end of the advance care planning process you will have signed two legally binding documents:

• An Advance Care Directive (ACD), in which you clearly state your medical treatment preferences.
• An Appointment of Enduring Guardianship, in which you nominate the person who will make decisions on your behalf when you no longer have capacity.

Importantly, while your ACD could include instructions to refuse, consent to, or withdraw from treatments, it cannot include a request for voluntary assisted dying (VAD) .

Why can’t I include voluntary assisted dying in an advance care directive?

Australia's VAD laws require that the person has decision-making capacity – from the time of request through to when the VAD substance is administered. An ACD, on the other hand, is used only when a person has lost their decision-making capacity. This means a person cannot make a request for VAD in advance and a substitute decision-maker is not allowed to request VAD on behalf of a loved one. 

It’s important to prepare for a voluntary assisted dying application

While VAD can't be requested in advance care planning documents, there are still things you can do to be ready should you become terminally ill and decide to go down the VAD pathway. The most important things are to have all your documents sorted and start the process early. VAD involves a strict assessment process with multiple safeguards, it is not meant to be an emergency procedure. 

Useful tips

Know your options - Your doctor is unlikely to suggest VAD to you. In fact, it’s illegal for them to do so in some states so it’s best to raise it yourself.

Start early - To avoid stress and delays, start the process as soon as possible. VAD applications can take weeks to finalise. For example, you must make three separate requests, be assessed by two doctors and there may be extra appointments if there are questions about your eligibility.

Prepare your documents - Some of the documents you may need include: your birth certificate, passport, marriage certificate (if you have changed your name) and proof of residence. Locating papers can be difficult at the best of times; it can be especially challenging when you are gravely unwell.

Contact the VAD Care Navigators - They are specially trained teams that support people through the voluntary assisted dying process. They have been variously described as "angels" and "guiding lights". They are a resource you should use.

Tell your aged care home or retirement village - Not all facilities allow voluntary assisted dying on their premises and other arrangements may need to be made. It's best to know your facility's position sooner rather than later.

You may want to speak to your loved ones about your plans - You will need help to get to medical appointments and emotional support along the way. However, if you prefer not to, it’s perfectly legal to keep your medical choices confidential.

You can pause, stop or change your mind at any time - Because you must retain decision-making capacity throughout the application, you can say you no longer want VAD, even right up until the last moment, and the process will stop immediately, no questions asked.

For more information, including how to download and fill out advance care planning forms, visit Advance Care Planning Australia.