Advance directives are an opportunity to make healthcare decisions ahead of time. An advance directive is created by a person with help from medical professionals and can be in the form of a written document or video. It sets out the treatments a person does and does not want in the future. If that person then becomes unwell and loses capacity to make decisions about their care, professionals will look to their advance directive to understand the patient’s wishes. In New Zealand, this is governed by the Code of Health and Disability Services Consumer’s Rights.
An advance directive might cover treatment methods such as artificial feeders, CPR, breathing machines and even a preferred place of treatment. As an example, you may like to indicate that if you suffer a major stroke you would prefer for professionals to work towards a natural death rather than depending on machinery for a long period of time.
Anyone can make an advance directive. They can be changed at any time and of course, if a medical event occurs and you do have capacity to make decisions, you can choose what steps you would like to take in that moment. Older persons, or those facing medical difficulties, should consider creating an advance directive in order to ensure their wishes are known should they lose capacity. Advance directives cannot be used to nominate someone to make decisions on your behalf, this is a separate process which involves appointing an Enduring Power of Attorney.
A common query is whether an advance directive will override what a medical professional or family member may prefer in the moment. Advance directives are not legally binding but will generally be followed by medical professionals if they are valid, and if it is ethical and practicable to do so. Exceptions to following advance directives may include a situation where the treatment you have requested is not available, or if the treatment is in breach of legislation. A common example of practicality occurs when an advance directive states that the person wishes to remain at home to receive treatment. While attorneys and professionals involved will do all they can to fulfil this wish, it may not be possible to provide the necessary care in the home or to install the necessary equipment.
It is also important to regularly review an advance directive to ensure it still reflects your preferences, particularly as medical technology continues to evolve.
