Advance Care Directive & Decision Maker | State Compliant

An Advance Care Directive is a written statement of your future health care wishes, made while you still have decision-making capacity, that takes effect only once you lose the ability to make or communicate those decisions yourself. It usually holds two kinds of content: binding instructions that consent to or refuse specific treatment, and non-binding values that describe how you want decisions weighed. In Victoria the binding part is called an instructional directive and the guidance part a values directive, a split created by the state and territory documents in our personal legal templates range so that each section carries the correct legal force.

A Medical Treatment Decision Maker is different. This is a living person, not a document clause, whom you authorise to make health decisions on your behalf when the directive is silent or when judgment is needed. The role has a different name in almost every jurisdiction. It is a Medical Treatment Decision Maker in Victoria, an enduring guardian in New South Wales, Western Australia and Tasmania, a substitute decision-maker in South Australia, and an attorney for personal matters under a Queensland Advance Health Directive or enduring power of attorney. Confusing the directive with the appointment is one of the most common and costly mistakes people make, because a directive without a decision maker leaves gaps, and a decision maker without a directive leaves them guessing.

Advance care planning in Australia is governed almost entirely at state and territory level, which is why the "right" document depends on your address. In Victoria, the Medical Treatment Planning and Decisions Act 2016 created a single legally binding Advance Care Directive and the appointment of a Medical Treatment Decision Maker, replacing a fragmented set of older instruments. A Victorian directive can contain an instructional directive that must be followed and a values directive that health practitioners must consider, and the medical treatment decision maker must decide according to what they believe the person would have wanted.

South Australia consolidated its regime into the Advance Care Directives Act 2013 (SA), under which a single advance care directive both records your wishes and appoints a substitute decision-maker who covers medical and lifestyle matters. The witnessing rules there are notably strict: under section 15 of that Act, a suitable authorised witness must certify that you understood the legal effect of the document and appeared to have capacity, and that witness cannot be your appointed decision-maker or anyone with an interest in your estate.

New South Wales sits at the other end of the spectrum. It has no statutory advance care directive form at all, so a common law directive relies on judge-made law, while the substitute decision-maker is appointed as an enduring guardian under the Guardianship Act 1987 (NSW). Queensland uses an Advance Health Directive under the Powers of Attorney Act 1998 (Qld), and Western Australia an Advance Health Directive under the Guardianship and Administration Act 1990 (WA), each with its own execution rules. For an authoritative plain-English map of how binding force differs across the country, the End of Life Law in Australia advance care directives comparison from QUT is the reference practitioners actually use. Because a form from one state is often refused in another, always use the version prescribed for where you live.

The everyday trigger is simply reaching an age or stage where you want a safety net in place before anything goes wrong. You are healthy, you have decision-making capacity today, and you want your future self protected: that is exactly the moment the law expects you to act, because a directive is only valid if made while you can still understand it. People who wait until a diagnosis lands often discover the window has closed. Alongside your will and your financial power of attorney, an Advance Care Directive completes a basic estate plan, which is why our personal legal documents including wills and powers of attorney are so often prepared together in one sitting.

Life changes are the next big prompt. A separation, a new partner, a new diagnosis, or simply changing your mind about who you trust with the decision each justify a fresh directive. A document naming an ex-spouse as your Medical Treatment Decision Maker, signed years ago and never revisited, is the kind of thing that detonates inside a family during a crisis. The same applies when the person you appointed has moved overseas, fallen ill, or is no longer someone you would trust in an emergency.

Then there are the acute situations. A parent's health is declining, and the family is trying to organise aged care, consent to treatment, and end-of-life choices while doctors wait for someone with authority. An edge case worth flagging: minors generally cannot appoint a decision maker themselves, and in Victoria a child's parent or guardian is recognised as the default decision maker instead. Another is dementia, where timing is everything, because a directive signed too late, once capacity is already in doubt, invites a challenge that can undo the whole document.

• The appointment of your Medical Treatment Decision Maker names the person (and ideally a substitute) using the exact role title your state recognises, whether that is enduring guardian in New South Wales or Medical Treatment Decision Maker in Victoria. Naming a backup matters because a single appointee who is overseas or unwell when the crisis hits can leave you with no valid decision maker at all.
• The instructional directive sets out the specific treatments you consent to or refuse, drafted in language clear enough that a clinician can act on it without second-guessing. Vague wording is the enemy here, so the template pushes you toward concrete statements about interventions such as resuscitation, ventilation, or artificial nutrition rather than general sentiment.
• The values directive records what matters to you: the outcomes you would find acceptable, your views on quality of life, and the beliefs that should guide any decision the instructions do not cover. This section is not binding in the same way, but health practitioners and your decision maker must take it into account, which is why it carries real weight in borderline cases.
• The witnessing and certification block is built to your jurisdiction's signing rules, because these vary sharply. South Australia demands an authorised witness who certifies your capacity and understanding under section 15 of the Advance Care Directives Act 2013, while Western Australia requires two adult witnesses, one authorised to take declarations such as a Justice of the Peace.
• The revocation and review statement confirms this document supersedes any earlier directive and prompts you to date it clearly, so there is never a dispute about which version governs. A well-drafted revocation clause quietly prevents the "battle of the forms" that arises when an old directive resurfaces after your death or incapacity.

Victoria runs the most fully integrated regime under the Medical Treatment Planning and Decisions Act 2016. Your Advance Care Directive can hold both a binding instructional directive and a values directive, and you appoint a Medical Treatment Decision Maker who must decide according to what they believe you would have wanted rather than their own preference. The forms are witnessed under the Act's specific requirements, and a support person can also be appointed to help you make and communicate decisions while you still have capacity. Victorians should know that a values directive, while not binding in the strict sense, must still be given effect where possible, so it is far from decorative.

New South Wales is the outlier: there is no statutory advance care directive form, so your written wishes take effect as a common law directive recognised by the courts, while your decision maker is appointed as an enduring guardian under the Guardianship Act 1987 (NSW). The appointment must be witnessed by an eligible witness, and once you lose capacity your enduring guardian can only resign with the approval of the NSW Civil and Administrative Tribunal. Because the directive itself is common law rather than statutory, clarity and dating are doubly important, since there is no prescribed form to fall back on if the wording is ambiguous.

Queensland uses an Advance Health Directive made under the Powers of Attorney Act 1998 (Qld), and it is worth knowing that only statutory advance health directives are legally binding in Queensland, not informal common law ones. The document lets you give directions about future treatment and appoint an attorney for personal and health matters, and it carries its own execution and medical certification requirements. Queenslanders often pair the directive with an enduring power of attorney so that financial and health authority sit in a coherent package.

South Australia consolidated everything into the Advance Care Directives Act 2013 (SA): one document records your wishes and appoints a substitute decision-maker covering both medical and lifestyle matters. The witnessing standard under section 15 is stricter than for an ordinary power of attorney, because the authorised witness must certify that you understood the legal effect and appeared to have capacity. Anyone appointed as your decision-maker, or with an interest in your estate, is disqualified from acting as that witness.

You start by telling the form where you live, because that single choice drives everything that follows. From there the template selects the correct document type and terminology for your state, so a Victorian receives a Medical Treatment Decision Maker appointment while a resident of New South Wales is guided toward an enduring guardian appointment under the Guardianship Act 1987. You then enter your own details and nominate your decision maker, along with a substitute if you have one, and the form prompts you to confirm each person has agreed to take on the role.

Next you work through your treatment wishes, separating the binding instructions from the values that should guide the harder judgment calls. The template offers plain-language prompts so you can be specific about interventions rather than leaving a clinician to interpret vague phrasing. Once the content is complete, it generates the witnessing and certification section tailored to your jurisdiction, then produces a clean editable Word file and a print-ready PDF. You sign in the presence of the witness your state requires, keep the original safe, and give copies to your decision maker, your GP, and ideally the hospital you are most likely to attend. For related authority over your money and property, many people prepare a financial enduring power of attorney from our personal document range at the same time.

The single most frequent error is treating one state's form as good enough for the whole country. It is not: a directive drafted for Queensland can be refused in Western Australia, and families discover this at the worst possible moment, at a hospital admission desk. Almost as common is signing too late, once capacity is already slipping, which hands a challenger the perfect ground to argue the document is invalid. People also forget the witnessing rules entirely, and a directive witnessed by the very person appointed as decision maker, or by a beneficiary of the estate, can be struck down under provisions like section 15 of the South Australian Act. When you are organising your affairs, it is worth reviewing your wills and estate planning templates so the whole plan stays consistent.

The other cluster of mistakes is about aftercare rather than drafting. A perfect directive locked in a drawer that nobody knows about is useless, so failing to distribute copies to your GP and decision maker defeats the entire exercise. Appointing two decision makers jointly, without saying what happens if they disagree or one is unreachable, builds a deadlock into the very moment you needed speed. And people routinely forget to revoke and replace an old directive after a separation or a change of heart, leaving two contradictory documents for a grieving family to fight over. Review the document whenever your relationships or health change, not once a decade.