Advance Health Directives

An Advance Health Directive only comes into effect if it applies to treatment a person requires, and only if the person becomes incapable of making or communicating their decisions. 

Valid Advance Health Directives are legal documents and health professionals must follow the decisions in their Advance Health Directive, except in some limited exceptions. A limited exception may occur if:

• circumstances relevant to the person’s treatment decision have changed since they made the treatment decision, and
• they could not have reasonably anticipated those changes when they made their Advance Health Directive, and
• it is likely that a reasonable person with knowledge of the change of circumstances would change their mind about the treatment decision.

Advance Health Directives sit at the top of the Hierarchy of treatment decision-makerswhich sets out the order health professionals must follow when seeking a treatment decision for a person who lacks the capacity to make their own judgements or communicate their decisions.

An Advance Health Directive cannot be used to:

• request voluntary assisted dying (VAD) as this requires a person to have decision-making capacity throughout the entire process. Individuals who are considering VAD can be referred to the WA VAD Statewide Care Navigator Service for support:
  • email VADcarenavigator@health.wa.gov.au
  • call 9431 2755
• request or authorise a health professional to take active steps to unnaturally end life
• request specific interventions that are not clinically indicated
• request treatment that is considered to be medically futile
• record wishes about organ and tissue donation – an AHD is ineffective after death.

To ensure an Advance Health Directive is valid, the make of the AHD must:

• be 18 years or older
• have full legal capacity at the time of making the Advance Health Directive.
• sign their Advance Health Directive in the presence of 2 witnesses aged 18 years or older, including one person who is authorised to witness statutory declarations in WA.
• make at least one treatment decision in Part 4 – My Advance Health Directive treatment decisions.

If there are concerns about the validity of an Advance Health Directive, and the person has capacity, health professionals should discuss these concerns with the person.

If the person does not have capacity, health professionals should:

• follow their organisation’s internal processes for resolution of such concerns
• seek advice from their professional association
• consider making an application to the State Administrative Tribunal (SAT) (external site) if there is any doubt about whether an Advance Health Directive or EPG applies in a given situation, and / or if concerns cannot be resolved.

Review the Take 5 education slides for a brief overview of health professional responsibilities starting with identifying a patient’s Advance Health Directive, right through to enacting and following treatment decisions.

Health professionals can support people to complete Advance Health Directives by:

• explaining Advance Health Directives are one option in WA to record values, beliefs and preferences during the advance care planning process.
• providing advice and guidance about treatment decisions to consider and the potential outcomes of their choices
• encouraging the person to write down their decisions about medical treatment in their own words
• offering information for the person to take away and consider e.g.:
• the Guide to Making an Advance Health Directive in WA (PDF 1.5MB) for instructions on completing AHDs  
• HealthyWA website for more information and to get a copy of the AHD.
• referring people to services to support advance care planning discussions and completing AHDs  e.g.
• Advance Care Planning Support Service (external site) provided by Palliative Care WA
• encouraging a review of advance care planning documents every 2 years or when there are changes to a person’s condition or health.

Tip: Use the Guide to Making an Advance Health Directive in WA (PDF 1.8MB) for instructions on how to complete an Advance Health Directive. 

Although the AHD may appear overwhelming due to its length, it is important to reassure individuals about the following:

• each page provides large blank spaces to allow individuals to record their responses which adds to the overall length of the form
• there are some sections which can be crossed out if the individual does not wish to complete them – these are clearly marked on the AHD
• the revised AHD provides the guidance and detail necessary to ensure individuals give ample consideration to the complex and important process of making future treatment decisions.