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.

The WA Advance Health Directive was updated in the Guardianship and Administration Act Regulations on 4 August 2022. The new Advance Health Directive:

• enables individuals to capture their values and preferences, in addition to treatment decisions
• includes more guidance and examples
• combines tick box and free text questions
• includes consent to medical research.

The benefits of these changes include:

• easier for people to understand and complete
• guides the process for both the person and health professionals
• Informs health professionals about the person’s values and preferences
• greater focus on person-centred care
• supports goals of care and shared decision-making.

Although the AHD may appear overwhelming to some individuals 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.

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.

Ask about AHDs as early as possible

• Ask your patient if they have an AHD.
• If they are unsure or can’t communicate:
  • ask their family/carer and/or GP
  • check patient records and My Health Record.

Store and communicate

• If patient has an AHD, raise a clinical alert and store AHD within patient’s record
• Mention the AHD and other care planning discussions in clinical handovers, including:
  • referrals
  • discharge summaries
  • outpatient correspondence
• Encourage patients to upload AHDs to their My Health Record.

Enact and follow

• If a person does not have decision-making capacity, refer to their Advance Health Directive and if relevant circumstances apply:
  • comply with the treatment decisions outlined within the Advance Health Directive
  • provide care in accordance with their values and preferences.
• If their Advance Health Directive does not cover the treatment decision required or they do not have an Advance Health Directive:
  • refer to the Hierarchy of treatment decision-makers for the order in which to consult decision-makers.

Review

• Suggest patients review their AHD when their health changes or at least every 2 – 5 years.

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

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 outcome(s) 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 
• encouraging a review of advance care planning document(s) every 2 years or when there are changes to a person’s condition or health.