Advance care planning is a process of thinking and talking about your values and goals and what your preferences are for current and future health care. It helps you to understand what the future might hold and say what health care you would or would not want, including end-of-life care. For more information visit: What is advance care planning?

An advance care plan is a document where you can share things that are important to you. This includes what is meaningful to you, such as people and pets, your values and the ways you would like those caring for you to look after your spiritual and emotional needs. It will also tell your loved ones and medical staff about the treatment and care you would or would not want if you are no longer able to tell them yourself.

It can also cover what sort of funeral you would like, whether you want to donate your organs, whether you want to be buried or cremated, where your important papers are and whether you have in place an enduring power of attorney or advance directive.

Any time is a good time to think about and share what’s important to you about your future health care. Advance care planning is just as important when you are young and healthy as when you become older or develop health problems. You never know what could be around the corner. You might not fill in everything now (such as your specific treatment or care), but these can be completed in the future.

You should involve the people you want to know your wishes for care and treatment if you can’t speak for yourself. This could include your whānau and friends, your doctor or specialist (particularly if you have been diagnosed with a serious illness) and other members of your health care team.

The Your plan section of our website has lots of tools to help you think about and write down what matters most to you.

To find our more visit Your plan (myacp.org.nz)

The role of your health care team is to listen to what matters to you and to talk about and help you plan for your future care and treatment. An advance care plan tells your health care team about the treatment and care you want if you are no longer able to tell them yourself. It’s a good idea to have a health professional’s help to fill out the specific treatment and care preferences section (section 6) of your advance care plan.

An advance care plan needs to be accessible to your health care team and whānau. With your consent, your doctor can forward it to others involved in your care. In some parts of the country, your advance care plan can be made available electronically to those caring for you and most Te Whatu Ora districts are working towards this. In the meantime, you should give a copy to your GP and any other health professionals you see regularly. Importantly, you should share the information in it with those closest to you.

You should take a copy of your advance care plan with you to planned hospital admissions.

Usually, those closest to you and your health care team will try to fulfil your preferences if you can no longer communicate with them. In some instances, though, this is not possible. For example, you may wish to remain at home when you are dying, but those closest to you may not be able to manage the care you need. This may mean you are admitted to a hospital, hospice or care home. It is also important for you to understand that treatments that will not medically benefit you will not be provided, even if you specifically ask for them.

You can go back and add to your plan as often as you like and change your decisions at any time. Advance care plans should be reviewed and updated regularly as and when situations change. It’s a good idea to review your plan annually, just to make sure your views, thoughts and wishes are the same and have been documented.

Everyone should do an advance care plan, whether they are well, unwell or in their last days. You may not need an advance care plan for many years, but you’ll be glad you have it. It is a good idea to start talking to those close to you, like parents or adult children, about their advance care planning wishes, and encouraging them to write an advance care plan too. This will put you in a better position to understand their thoughts and feelings and support them if their health situation changed.

Your advance care plan is your way of sharing what is important to you now and at the end of your life. This is especially important if you become unwell and can no longer tell people yourself.

This might include things like taking out tubes and lines and stopping medications that aren’t adding to your comfort. Or letting people know whether you would like to be cared for at home, hospice or in hospital. Or what things you would like to happen to ensure your spiritual or cultural needs are meet. In New Zealand the information you have written in your advance care plan has legal standing. This means your health care team has a responsibility to take the things you have said are important to you, into consideration when they are planning your care or suggesting treatment options.

An advance directive (sometimes called a living will) outlines if there are specific medical treatments you would or would not want in a specific situation in the future. An advance directive only comes into play when you are unable to consent to the treatment being offered to you, yourself. Often because you are too unwell or have lost capacity to communicate.

An advance directive can be part of your advance care plan (section 6), a standalone document or something you state verbally. An advance directive does not need to be signed or dated. However, signing and dating your directive, helps your health care team to know when you developed it and what you understood about your condition at the time. Providing the directive as part of an advance care plan will give clinicians more information and context about who you are and why this decision is important to you.

Valid advance directives are legally binding. An advance directive is considered valid when created by a person who has mental capacity to make the directive. They need to have made it freely and without undue influence and have understood the risks, benefits and consequences of consenting to or refusing the specific treatment. The directive needs to be clear on the circumstances it will apply to, so when a clinician comes to use it they are sure it is what you would have wanted. For example: ‘if I had a severe stroke and was unable to recognise anyone, I would like my care to focus on allowing a natural death. I would accept comfort measures but refuse artificial feeding.’

An advance directive is legally binding even if a refusal of treatment is not what is in the person’s best interests from the clinician’s perspective. Just like when a person is competent and refuses a treatment, treatment cannot be forced on them.

To learn more, watch this video which is designed to help clinicians understand the legal framework of advance care planning including enduring powers of attorney for personal care and welfare and advance directives.

An enduring power of attorney is the person you appoint to make or communicate care and welfare decisions on your behalf if you can’t do this yourself. It is a formal document which is prepared by, and signed in the presence of, a lawyer. Your enduring power of attorney can be anyone you choose, a friend, whānau member or someone else you trust. It is important this person knows your wishes, feelings and values to help them make the best decisions on your behalf if they need to. It is a good idea to include this person in your advance care planning discussions, particularly those relating to future treatment options, and to give them a copy of your advance care plan.

There are some decisions that by law an enduring power of attorney cannot make, including refusing consent to standard medical treatment intended to save that person’s life or to prevent serious damage to their health. Your enduring power of attorney can tell your medical team what they think you would or would have wanted but they can’t write an advance care plan or an advance directive for you. Only you can make your advance care plan or directive, no one else.

To learn more, watch this video which is designed to help clinicians understand the legal framework of advance care planning including enduring powers of attorney for personal care and welfare and advance directives.