An Advance Care Directive (ACD) tells doctors what medical treatment you would and would not want if you lose the capacity to speak for yourself — and, in most states, lets you appoint a substitute decision-maker to make medical decisions on your behalf.
It is one of the most important documents you can have, and one of the least talked about. According to Advance Care Planning Australia, around two-thirds of Australians have not done any formal advance care planning. The result, every day, in every hospital in the country: families forced to guess at the wishes of someone they love, often in the worst possible circumstances.
What an ACD is — and is not
An ACD is a document about your healthcare, made while you are well, to be used during your lifetime if you cannot make decisions for yourself. It is not a will (a will deals with what happens after you die). It is not an enduring power of attorney for financial matters (that is a separate document). And it is not the same as an organ donation registration (though it can include your wishes about that).
An ACD typically does two things:
- States your wishes about treatment — things like life support, organ donation, pain management, refusal of specific treatments, and any religious or cultural considerations.
- Appoints a substitute decision-maker — the person who can make medical decisions on your behalf. They are bound to follow your stated wishes where you have expressed them, and to act in your best interests where you have not.
Without an ACD, doctors must fall back on your state's guardianship law to identify a "person responsible" — typically your spouse, then your closest relative. That may or may not be the person you would actually choose, and they may or may not know what you would want.
The 8 Australian jurisdictions, side by side
Each state and territory has its own legislation, its own name for the document, and its own witnessing requirements. The good news: every state recognises some form of advance care planning, and most accept directives made in other states if they are clear and validly executed. The bad news: forms and rules are not portable — make yours under your home jurisdiction.
| State/Territory | Document name | Key legislation |
|---|---|---|
| NSW | Advance Care Directive (common law); Enduring Guardianship appoints a decision-maker separately | Common law; Guardianship Act 1987 (for Enduring Guardianship) |
| VIC | Advance Care Directive — can include an "instructional directive" (binding) and/or a "values directive" (guides decisions) | Medical Treatment Planning and Decisions Act 2016 |
| QLD | Advance Health Directive | Powers of Attorney Act 1998 |
| SA | Advance Care Directive | Advance Care Directives Act 2013 |
| WA | Advance Health Directive | Guardianship and Administration Act 1990 |
| TAS | Statement of Wishes for Care (common law); Enduring Guardianship appoints a decision-maker separately | Common law; Guardianship and Administration Act 1995 |
| ACT | Health Direction | Medical Treatment (Health Directions) Act 2006 |
| NT | Advance Personal Plan | Advance Personal Planning Act 2013 |
Each jurisdiction publishes its own form, available free from the state health department or equivalent. Most also accept your own written document — provided it is signed, witnessed, and unambiguous — but the official form is usually the safest path, because every Australian doctor and paramedic has been trained to recognise it.
What goes into an ACD
Different forms ask different questions, but most cover the same ground:
- Your values. What "living well" looks like for you. What you would find unacceptable as a long-term outcome.
- Life-sustaining treatment. CPR, mechanical ventilation, artificial nutrition and hydration, dialysis. Which you would want and in which circumstances.
- Palliative care preferences. Where you would prefer to die. Whether you would prefer comfort over aggressive treatment in terminal phases.
- Organ and tissue donation. Your wishes here — though Australia operates an opt-in register and your family is usually asked at the time regardless.
- Religious or cultural considerations. Any specific practices that must or must not be observed.
- Your substitute decision-maker. Who they are, contact details, and any limits on their authority.
Witnessing and signing
Witnessing rules vary considerably by state. Most require at least one witness; some require two. Some require the witness to be a medical practitioner. Some require the witness to certify that you appeared to have capacity at the time. Check the specific form for your state — getting witnessing wrong can render the directive invalid.
You should review and re-sign your ACD periodically — generally every few years, and whenever your circumstances change (new diagnosis, change of substitute decision-maker, new strong views). A 20-year-old ACD that no longer reflects your wishes may be disregarded.
Where to store it (this is the part that fails)
An ACD that nobody can find at 3am in an emergency department is no better than no ACD at all. The minimum reliable distribution:
- Your treating GP, on file with your medical record.
- Your substitute decision-maker, with the original or a certified copy.
- Your hospital of preference, if you have one — many will accept and file a copy on your record.
- A place your family knows to look — a vault, a safe, a labelled folder, or somewhere equivalent. Not a drawer.
Vault Premium includes the Advance Care Directive Builder, with state-specific terminology and a structured form that guides you through values, treatment preferences, and substitute decision-maker appointment. The completed document lives in your vault, accessible to your substitute decision-maker the moment the vault is released — and, if you choose, available to your treating doctor on demand during your lifetime.
The single most important thing
Talk to your substitute decision-maker before you sign. An ACD is a document, but the real work is the conversation: telling someone you love what you actually want, in plain language, while you are well and can answer their questions. That conversation is the difference between a directive that gets honoured and one that gets argued about.