Advance Care Directive · Updated 11 May 2026
Advance Care Directive Australia: How to Make Yours (State-by-State 2026)
If you can\'t speak for yourself due to coma, severe stroke, advanced dementia, or end-stage illness — who decides whether you get CPR, intubation, or artificial nutrition? An Advance Care Directive (ACD) is the legally binding document that ensures the answer is YOUR wishes, not your family\'s best guess. Most Australians don\'t have one. This is a thorough state-by-state guide to creating yours — free + within a single weekend.
★Key takeaways
- ✓Advance Care Directives (ACDs) are LEGALLY BINDING healthcare instructions used when you lose decision-making capacity.
- ✓Every Australian state has its own form + name — but the principle is identical across NSW, VIC, QLD, WA, SA, TAS, ACT, NT.
- ✓Free to complete. GP can help via Medicare item 90089/90090. Witnessing requirements vary by state.
- ✓Upload to My Health Record (myhealthrecord.gov.au) so emergency departments can find it 24/7.
- ✓Without an ACD: medical team consults your "person responsible" (typically spouse, then adult child) — risks family conflict + decisions misaligned with your wishes.
| Provider ⇅ | Legislation ⇅ | Form name ⇅ | Issuing body ⇅ | Cost + requirements ⇅ |
|---|---|---|---|---|
| NSW | Common law (no statutory form) | Enduring Guardianship Act 1987 for appointing decision-maker | NSW Trustee + Guardian forms | Free; templates online |
| VIC | Medical Treatment Planning and Decisions Act 2016 | Instructional + Values Directive forms | Office of the Public Advocate | Free; pharmacist + JP can witness |
| QLD | Powers of Attorney Act 1998 | Advance Health Directive form | Queensland Department of Justice | $140 to lodge if witnessed by JP; free elsewhere |
| WA | Guardianship and Administration Act 1990 | Advance Health Directive form | WA Department of Health | Free; requires 2 witnesses incl 1 healthcare professional |
| SA | Advance Care Directives Act 2013 | Advance Care Directive form | SA Office of the Public Advocate | Free; one-stop form |
| TAS | Guardianship and Administration Act 1995 | Personal Health Care Plan template | Tasmanian Department of Justice | Free; less formalised than other states |
| ACT | Medical Treatment (Health Directions) Act 2006 | Health Direction form | ACT Justice + Community Safety | Free; can include CPR refusal |
| NT | Advance Personal Planning Act 2013 | Advance Personal Plan | NT Department of Justice | Free; comprehensive form covers health + finances |
Form names + legislation current as at May 2026. Always download the latest version from your state's official issuing body — older forms may not be current law.
| Provider ⇅ | What it is ⇅ | Why it matters ⇅ | Tip ⇅ |
|---|---|---|---|
| Substitute decision-maker(s) | Named person(s) authorised to make health decisions on your behalf | Choose someone who knows your values + can advocate firmly | Discuss with them BEFORE naming |
| Specific treatment preferences | CPR / intubation / artificial nutrition / dialysis / antibiotics — accept or refuse | Be specific: under what conditions? Permanent loss of consciousness? | Discuss with GP |
| Values statement | What matters to you about quality of life vs prolonging life | Helps decision-makers interpret your wishes in unforeseen scenarios | Write in your own words |
| Religious or cultural requirements | Spiritual care needs, dietary, end-of-life rituals | Especially important if attending residential aged care | Note for staff awareness |
| Organ + tissue donation | Yes/no/specific exclusions | DonateLife register is separate but referenced | Confirm with family |
| Funeral preferences | Burial / cremation / location / specific instructions | Not strictly part of ACD but often included | Reduces family stress at the time |
The most useful ACDs combine specific medical instructions WITH a values statement explaining your priorities. Pure tick-box forms miss nuance; pure values statements lack specificity. Aim for both.
Why most Australians don\'t have one (and why that\'s a problem)
Research from Advance Care Planning Australia consistently shows that fewer than 15% of Australian adults have a formal ACD. The reasons are familiar: it\'s emotionally uncomfortable, it feels premature, the forms feel intimidating, "my family knows what I want."
The cost of NOT having one: medical teams default to "do everything possible" unless told otherwise. ICU admissions for terminal patients. Resuscitation of frail elderly with poor prognosis. Family conflict about whether to withdraw treatment. Decisions made by exhausted partners + adult children at 3am.
The cost of HAVING one: a few hours of paperwork + a GP appointment. That\'s the trade.
The 60-minute weekend ACD
You can complete a workable ACD in a single weekend:
- Friday evening: Download your state\'s form from the official site. Read once cover-to-cover (it\'s 6-12 pages). Identify your substitute decision-maker(s).
- Saturday morning: Have the conversation with your nominated substitute decision-maker(s). Tell them what you want + don\'t want. Ask if they\'re willing.
- Saturday afternoon: Complete the form in draft. Write your values statement. Note any specific treatment preferences. Leave for 24 hours to reconsider.
- Sunday: Re-read your draft. Adjust. Sign in the presence of required witnesses (varies by state). Many JPs + pharmacists can witness for free.
- Following Monday: Upload to My Health Record. Send a copy to your GP. Distribute copies to your substitute decision-maker + family members.
That\'s it. Done. You can refine over time — but having the basic ACD in place removes the biggest legal + emotional risk for your family.
Conversations that make the form 10x more useful
The form is the legal instrument; the conversation is how it actually gets implemented. Tell your substitute decision-maker:
- What states of being would you consider "worse than death" (permanent unconsciousness? severe dementia? full dependence on machines?)
- What do you want them to push back against if a medical team suggests aggressive treatment that you\'d refuse?
- What about pain management — are you willing to accept sedation that hastens death if it relieves severe pain (palliative sedation)?
- Where do you want to die — home, hospital, hospice, aged-care facility?
- What about hydration + feeding tubes in late dementia? (This is the question most Australian families face.)
Have this conversation twice. Once now. Once again in 2-3 years. Wishes change with experience + age.
Common questions
What\'s the difference between an Advance Care Directive and a Will?
A Will distributes your assets AFTER death — it has no legal force during your lifetime. An Advance Care Directive (ACD) documents your healthcare wishes WHILE you\'re alive but unable to communicate (coma, dementia, severe stroke). They\'re completely separate legal instruments and serve different purposes. You should have both — most adults have neither. Without an ACD, your family + medical team make decisions on your behalf without knowing your specific wishes.
When does an ACD take effect?
Only when you LOSE capacity to make + communicate decisions yourself. As long as you can speak + understand, you make your own decisions — your ACD is irrelevant. The transition is determined by your treating doctor: typically requires assessment by 2 doctors that you\'ve lost decision-making capacity. Common triggers: severe stroke, advanced dementia, irreversible coma, ICU sedation, end-stage terminal illness.
Can I refuse CPR through an ACD?
Yes, in every Australian state and territory. You can specify "no CPR" (Do Not Resuscitate / Allow Natural Death) under defined conditions. Common scenarios: "if I have advanced dementia AND a cardiac arrest, do not resuscitate"; "if I have permanent loss of consciousness, do not intubate". You can be as specific or as broad as you wish. Discuss with your GP — they can help articulate exact medical scenarios.
What\'s a substitute decision-maker?
A person you appoint to make healthcare decisions on your behalf when you lose capacity. Different states call them different names: Enduring Guardian (NSW, WA, TAS), Medical Treatment Decision Maker (VIC), Substitute Decision Maker (SA), Health Attorney (QLD), Health Decision-Maker (ACT, NT). They MUST follow your ACD instructions where applicable, and act in your best interest where not specified.
How do I choose a substitute decision-maker?
Choose someone who: (1) knows your values + has heard you discuss end-of-life wishes, (2) is geographically close enough to attend medical meetings, (3) is emotionally capable of making hard decisions under pressure, (4) will advocate firmly with medical teams (not just defer to doctors), (5) is younger than you ideally (to outlive you). Discuss the role with them BEFORE naming — make sure they\'re willing + understand your wishes. Many people name a spouse + an adult child as backup.
Can my GP help me complete an ACD?
Yes — and they should. GPs are encouraged to discuss advance care planning with patients aged 75+ or with chronic conditions. Medicare item 90089 + 90090 allow GPs to bill for advance care planning consultations. Many GPs welcome these conversations + can help articulate medical scenarios + treatment preferences. Book a longer appointment (45-60 minutes) — this isn\'t a 10-minute consult.
Where should I store my ACD?
Multiple copies: (1) original with your substitute decision-maker, (2) copy with your GP / aged-care facility, (3) copy uploaded to your My Health Record (myhealthrecord.gov.au), (4) copy with your solicitor + executor, (5) copy in your home where family can find quickly. Tell your family + close friends WHERE the document is — there\'s no value in an ACD that can\'t be located in an emergency.
How do I upload my ACD to My Health Record?
Log in to My Health Record (myhealthrecord.gov.au), navigate to "Advance Care Planning Documents", and upload as PDF. Your treating doctors + emergency department staff can access this if you\'re unconscious + identified by Medicare number. Make sure your ACD is signed + witnessed before upload. Also notify your GP — they can upload on your behalf if you prefer.
Can I change or revoke my ACD?
Yes, anytime — provided you have capacity. Best practice: review every 2-3 years, after major life events (cancer diagnosis, spouse death, dementia diagnosis), or after any change in your medical situation. To revoke: physically destroy the original + replace, OR sign a new version that supersedes prior versions. Notify all copy-holders + update My Health Record. Family members may dispute changes if they don\'t reflect long-stated preferences — discuss openly.
Is an ACD legally binding?
Yes — but with caveats. In all Australian states, healthcare providers MUST follow a valid ACD. Specific provisions that are clear, current, witnessed correctly, and apply to the actual medical situation are binding. Gray areas: (1) instructions referencing unforeseen medical scenarios may be interpreted by your decision-maker, (2) instructions conflicting with current best-medical-practice may be discussed but not overridden lightly, (3) emergency life-saving treatment may proceed if there\'s doubt about validity or applicability. Get the form right + keep it current to maximise enforceability.
What happens if I don\'t have an ACD?
Statutory default applies: medical team consults your "person responsible" (spouse, then adult child, then parent, then sibling — in roughly that priority order in most states). They make decisions on your behalf using their best understanding of your wishes. Risks: (1) family disagreement about what you would want, (2) decisions made under emotional pressure, (3) treatment continued or withdrawn against your actual wishes, (4) family guilt + conflict at + after your death. An ACD prevents most of this — it\'s a gift to your family.
Should I have an ACD before entering aged care?
Strongly recommended. Most residential aged-care facilities ask about your ACD as part of admission. If you don\'t have one, they\'ll often offer to help facilitate one with your GP. Having an ACD in place before admission means: (1) your wishes are clear from day one, (2) staff know how to respond to medical emergencies (e.g. unwitnessed fall + cardiac arrest), (3) your substitute decision-maker is clearly identified, (4) end-of-life care planning is easier. Ideally complete BEFORE admission, not after.
Next step
If you\'re comparing aged-care facilities, use our tour checklist — it includes ACD + advance care planning questions to raise. Also browse 60 verified facilities with ACQSC star ratings.