Making a will? Why not plan your end-of-life care too

Just 14% of Australians have an advance care plan. Simplificamos Su Trabajo/Flickr, CC BY-NC

More than half of Australians have a will (59%) to determine how their property will be divided after they die. And 30% have appointed a power of attorney to make financial decisions if they lose the capacity to do so.

But new research just published in the Internal Medicine Journal shows few Australians have drawn up plans for the treatment they want – or don’t want – at the end of life.

Advance care planning allows people to plan for a better death by telling their loved ones how they want to be cared for at the end of their life. Part of advance care planning can include putting these wishes into a legal document called an advance directive.

A good time to start making these sorts of decisions is when you make a will.

National picture

Advance directives vary depending on where you live. In six Australian states, there is an official advance directive form, created by legislation. New South Wales and Tasmania, however, rely on the common law (law made by judges) recognition of advance directives.

In all states, advance directives are available online and sometimes at places such as newsagents and post offices.

Our research provides the first national data on the proportion of Australians who have completed an advance directive. Overall, just 14.4% of Australian adults have one, with significant variation between states.

Using the largest state, New South Wales (13.3%), as our comparator, you are more likely to have an advance directive if you are from South Australia (21%) and Queensland (19%), and less likely if you are from Western Australia (7.5%).

There is variation in the other states too – the Australian Capital Territory (18.5%), Tasmania (15.1%), Victoria (13.4%) and the Northern Territory (9%) – but they weren’t sufficiently different from NSW to be significant from a statistical perspective.

Differences in state laws and practices are likely to account for some of the differences. There is also variability in the usability of advance directive forms (length or how readily available they are to the public) and education of the community and health professionals.

One reason why South Australians and Queenslanders are more likely to have an advance directive is that these states have a long-standing and recognised advance directive form, backed by legislation, where a person can record both their refusal or acceptance of medical treatment.

Some of these features are missing in other jurisdictions. New South Wales and Tasmania, for example, do not have legislation supporting advance directives, and some states only allow advance directives to refuse treatment and not be used to make broader plans about future health care.

To encourage greater advance care planning, policymakers need to ensure advance directives are recognised in legislation, allow people to make a range of decisions about end-of-life care (not just refusing treatment) and are well publicised to health professionals and to the community.

Getting your plans in order

The strongest predictor of someone having an advance directive is the completion of other planning documents. Our study found that people who completed a financial enduring power of attorney were nine times more likely to have an advance directive than those who hadn’t. Those with a will were 2.5 times more likely to have an advance directive than those without.

This presents an opportunity to increase advance care planning, outside the health setting. Those responsible for advising in these broader future planning processes, including lawyers and financial planners, should be co-opted into efforts to encourage people to plan not only for their financial future but for their health as well.

When advising a client on their will, for instance, a lawyer should explain what advance directives are and provide information to help the client decide if they would like to complete one.

This may pose challenges to make sure that advance directives completed outside the health system have sufficient input from health professionals to ensure, for example, that a directive represents an informed decision. But these issues could be addressed by legal professionals and financial advisors connecting clients with an appropriate health professional for advice.

Given the challenges of getting Australians to engage in advance care planning, we need to think broadly about all possible triggers for having discussions about future health decision-making. This includes not only health-related events, such as admission to hospital or entry to an aged care facility, but also when people are making plans about other aspects of their life.