We all have questions about the end of life, even though we usually don’t want to know the answers. It’s a tough subject to raise and discuss.

But there’s one thing that you do need to talk about with your family, as early as possible – and that’s planning in advance – so that your wishes are known and recorded for when the time comes.

Advance Care Planning is just like making a Will – it’s all part of planning for the future. It’s best to do it when you’re healthy and well. There’s no harm in deciding now – what sort of medical treatment do you want? Or not want? What medications would you like to be treated with, or not treated with? Remember, the end of life is different for different people, and you may or may not be able to communicate your wishes.

An advance directive is a statement signed by a person setting out in advance the treatment wanted or not wanted in the event of becoming unwell in the future. An advance directive can be a good way to gain more control over the treatment and care you are given if you experience an episode of mental illness that leaves you unable to decide or communicate your preferences at the time.

Getting Started

It’s not difficult to make an advance directive. You don’t need a lawyer. In fact, you have the right to make an advance directive without involving anyone else in its preparation. However, taking the following steps will help ensure that your advance directive is respected, and the decisions contained within it acknowledged and acted upon.

  • If possible, make your advance directive in writing rather than verbally. State your preferences as clearly as you can, then sign and date it.
  • If you prepare your advance directive with the help of your clinician or another health worker, he or she can verify that you are competent and sufficiently informed about your stated preferences and can help you clarify the type of situation you intend your directive to cover.
  • If you involve your family/whānau in preparing your advance directive, or at least inform them of it, they will be better equipped to support you and to advocate for your wishes in a crisis.
  • Regularly review and update your advance directive so that it reflects any changes in your condition or your preferences and is viewed by clinicians as still representing your wishes.
  • Keep a copy of your advance directive yourself, and give copies to your family or support persons, and the clinicians most often involved in your care.

(Source: https://www.hdc.org.nz/your-rights/about-the-code/advance-directives-enduring-powers-of-attorney/)

There is no wrong or right way to capture information. You only need to fill in the bits you want to. Once you have captured everything you want, share this with your general practice team and keep a copy with you. You’ll need to take this with you if you go into care or a hospital.

There are two types of advance care plans you can use. The full plan and guide (you can order a hard copy and write into it) or the plan part only (can be printed and written on or completed electronically). Please visit the Health Quality and Safety Commission website to access the forms.

Deciding Your Future

If you’re unsure what to take into account when making your decisions about future care, have a look at the Advance Care Planning website. It offers helpful advice about considering your current state of health, your future state of health and the impact of any past experiences of healthcare.

It also encourages you to discuss all your decisions with everyone around you:
“Speak to your family and others close to you about your views and preference for your medical care. A close or loving relationship does not always mean someone knows or understands your preferences. The more your loved ones understand your preferences, the easier it will be for them to help guide your medical treatment. You should also speak to your doctor. They can provide you with information and advice regarding your current health situation and what may happen in the future.”

(Source: https://www.hqsc.govt.nz/our-programmes/advance-care-planning/information-for-consumers/about-acp/)

Advance Health Directives

Once you’ve decided on your preferred care plan, it’s best to put your wishes in writing by making an Advance Health Directive. Remember, it comes into effect only if your cognitive
health deteriorates, and you become unable to make your own decisions. To access the advance care planning forms visit the website.

When you’ve written your Advance Health Directive, you or your doctor can add it to your health records online (Manage My Health) for any future medical staff to see.

What about nominating someone to make decisions on my behalf?

In some countries your advance directive can include a nominated person to make decisions on your behalf. However, in New Zealand you need to appoint a person to be your enduring power of attorney in relation to your personal care and welfare, through the Protection of Personal Property Rights Act 1988. If you wish, you can give this person the power to make healthcare decisions on your behalf when you are not competent to do so yourself.

You should seek advice from a lawyer if you wish to appoint someone as your enduring power of attorney.
(Source: https://www.hdc.org.nz/your-rights/about-the-code/advance-directives-enduring-powers-of-attorney/)

You can also find more details about Enduring Power of Attorney on the Ministry of Justice website.

Just Do It

Don’t put off making an Advance Health Directive. The best time to do it is now, before any urgent health condition arises. It’s particularly important to make one if:

  • You’re about to be admitted to hospital
  • Your medical condition is likely to affect your ability to make decisions in the future
  • You have a chronic medical condition that could cause serious complications, such as diabetes, asthma and heart or kidney disease.

If you need any more convincing to make your Advance Health Directive a priority, remember that it benefits everyone: you, your family, your carers and your health professionals. It helps you to ensure you receive the care you want, in the specific location that you want to be receiving care (such as your own home, or a hospital if you prefer). It can also improve ongoing and end-of-life care by properly informing your current and future healthcare workers of your wishes, which may reduce unnecessary transfers to hospitals or unwanted treatments and medications.

Certainty Offers Comfort

Advance Health Directives allow everyone in your family the comfort of knowing you are receiving the care you wanted, in the way you wanted, at the time you need it. They may help you and your family members be more certain, satisfied and assured during what will undoubtedly be a challenging time.

Planning head is always easier to do when you are fit and healthy. So, start the conversation with your loved ones now, and talk about the type of health care you would prefer. Make others aware of your wishes by putting it all in writing. Help them make the right decisions at the right time for you. It will make a very difficult time a lot easier, and put your mind at ease that your wishes will be carried out.

We owe it to our loved ones to be prepared. The last thing you want is to leave your family worrying about what decisions you might have made differently. Take charge now and get your wishes and affairs in order.