Advance Care Directives in Tasmania: Who Will Speak for You?
In brief
An Advance Care Directive is a legally binding document that records your instructions about future health care and treatment, to be used if you cannot make or communicate those decisions for yourself. In Tasmania, it can work alongside an Enduring Guardianship, which is the separate arrangement used to appoint someone to make personal or health decisions on your behalf.
Advance Care Directives are something I am deeply passionate about.
At their heart, they answer one simple but profoundly important question:
Who is going to make medical and health care decisions on my behalf, and what guidance will they have, if I am unable to make those decisions for myself?
In Tasmania, these are two closely related but distinct parts of planning ahead. An Advance Care Directive records your instructions and wishes about future health care and treatment. If you want to formally appoint someone to make personal or health decisions for you, that is generally done separately through an Enduring Guardianship. The two can work together.
To put this another way
An Advance Care Directive is only referred to should you be unable to make or communicate decisions about your health care for yourself.
"I'm young. I'm healthy. I don't skydive for a living. How would I ever end up in that position?" I hear you ask.
The reality is that life is full of unforeseen twists and shadows. A motor vehicle accident. A sudden stroke. A heart attack. A serious illness. These events can happen to anyone, at any age. They are not the exclusive domain of the elderly or those already living with poor health.
Yet, much like conversations about death itself, thinking about Advance Care Directives is something many of us keep kicking down the road. It's uncomfortable, so we tell ourselves it's something to worry about later, and most likely for someone else.
Finding the courage to think about these issues is an important first step. But we also need to ask ourselves another question:
So perhaps the question we should all be asking ourselves isn't whether we're old enough or sick enough to complete an Advance Care Directive
It's much simpler than that.
Who do I trust to speak for me if one day I cannot speak for myself?
A well-considered Advance Care Directive provides clear guidance for those who may one day be asked to make incredibly difficult and important decisions. It allows them to act with confidence, knowing they are honouring your wishes rather than trying to guess what you might have wanted.
Working out what matters to you
But how do we actually work out what those wishes are?
Before Tasmania formally recognised Advance Care Directives in legislation, there was a wonderful planning resource called Five Wishes. It encourages people to think beyond a simple "Do Not Resuscitate" instruction and explore what mattered most to them.
Five Wishes is an American planning resource rather than Tasmania's legal form, but its questions can still be a useful prompt for reflection.
What does "life support" actually mean to me?
Which treatments and supports would I want—and under what circumstances?
If I were unconscious, would I like people to play music? If so, what sort of music? Would I like someone to read to me? And please, heaven forbid, don’t play some sombre dirge and don't read Plato! I'm much more of an indie pop and Marian Keyes kind of person.
These details might sound small, but they are deeply personal. They remind those caring for us that we're not simply patients—we're people.
What makes life meaningful to you?
Another excellent resource is MyValues, developed by Australian intensive care specialist Dr Charlie Corke. It invites us to reflect on what gives our life meaning.
How important is my career?
Time with family?
Travelling?
Playing golf?
Cheering for my beloved St Kilda... even if they continue to lose again... and again... and again.
Understanding what matters most to us provides invaluable guideposts for those making decisions on our behalf. It helps them weigh not just whether we can survive, but what kind of life we would consider meaningful, if we did.
Making things gentler for the people you love
It's also worth remembering that families, friends and healthcare professionals are all human. Every one of them wants to do the best they can for someone they are caring for. But making life-changing decisions without knowing a person's wishes can place an enormous emotional burden on those left behind.
None of us are going to live forever, despite peptides, supplements and remarkable advances in medicine.
So regardless of your age, your health or your occupation, having an Advance Care Directive is simply a sensible act of planning. It allows you to retain a voice, even at a time when you may no longer be able to use it.
After all, just as talking about sex won't make you pregnant, completing an Advance Care Directive won't make you need one.
But if the unexpected ever happens, it may become one of the greatest gifts you leave to the people who love you.
A gentle place to begin
If this has prompted you to think about your own wishes, you do not need to work everything out at once. You can begin by reading the Tasmanian Advance Care Directive information, talking with the people you trust, and speaking with your GP or healthcare team. Mary Eleanor's end-of-life doula team can help you begin a gentle conversation about planning ahead. You can also explore our pre-planning information and free Pre-Planning Pack, or browse our other guides to funeral and end-of-life care in Tasmania.