Advance care planning in Australia: challenges of a federal legislative system

There is increasing attention in Australia and internationally on advance care planning (ACP), a process which assists competent people to make decisions about their healthcare for a possible future time when they may no longer be competent. ACP can include the use of a written document and/or use of a substitute decision-maker to make healthcare decisions at a time of future incompetence. ACP is much more prevalent in the US than in Australia or other English-speaking countries. Australia is a federation of states and territories, which all make their own health law, resulting in different legislative provision, documentation and terminology. Despite research demonstrating strong support for ACP, it is not well understood, nor is it well utilised. Even in public hospitals, incorrect terminology and documentation put health professionals at risk. A recent position statement by the Australian Medical Association (AMA) recommends uniform national legislation for legally enforceable advance directives. Unfortunately, the AMA statement also proposes allowing doctors to ignore an advance healthcare directive if the doctor believes that it is 'inconsistent with good medical practice or advances in medical science, thereby preserving doctors' clinical judgement and discretion'. It is a fundamental pillar of the doctor/patient relationship that it is the patient who ultimately holds the power to consent to, or refuse, treatment. Competent patients must always have the last say over what happens to their bodies. For those who fear loss of capacity, ACP can provide reassurance and take away some of the fear around the end stage of life.