Eol Brochure Oct 2011

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END-OF-LIFE PLANNING

A PLAIN LANGUAGE GUIDE TO DOCUMENTING YOUR WISHES

AND

CHOOSING AN ENDURING GUARDIAN OR PERSON RESPONSIBLE

NOTE: While the principles underlying end-of-life planning are fairly universal, the law and

support structures available differ between countries and, within Australia, from State to

State. This document is written around Tasmanian law and institutions and will need

interpretation when read elsewhere.

While the document can be read on its own, it is designed primarily as supporting

documentation to an interactive end-of-life planning seminar developed by DwD Tasmania.

October 2011


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DYING WITH DIGNITY TASMANIA (INC)

Dying with Dignity Tasmania (DwDTas) is a community organisation with a focus across end-of-life

issues.

Our objectives are to support, promote and work for:

(1) the right of everyone to make decisions about their death and dying with the same freedom of

choice, personal autonomy and human rights that they have in other aspects of their lives

(2) the right of everyone to die with dignity, as they see it

(3) end-of-life and advance care planning to enable everyone to express their wishes and to have

them respected

(4) accessible, quality services, including palliative care, that assist people to have a dying process

and death they regard as dignified, and

(5) law reform consistent with the above.

To achieve these objectives, we:

promote improvements in end-of-life planning, services and practices advocate and lobby for law reform research and maintain up-to-date information on the legal, ethical, political and practical issues

surrounding end-of-life reforms

provide information and advice on end-of-life planning and other issues, and work cooperatively with other organisations with similar aims, including YourLastRight.com,

the national alliance of State and Territory dying with dignity and voluntary euthanasia

societies.

One of our major priorities is to improve timely end-of-life and advance care planning across the

community. This includes promotion of the preparation of Enduring Guardianships and their

registration with the Guardianship and Administration Board. Our core belief is that individuals

should be able to undertake their own planning and be able to exercise choice in accordance with

their own ethics and beliefs.

We are strong supporters of palliative care which can provide many people with sufficient comfort

and relief from suffering for them to have a dignified death. We promote and support access to

quality palliative care for all Tasmanians in their own homes or in a caring and appropriate facility.

We also have a nominee on the Palliative Care Clinical Network Steering Committee.

However, not everyone is fortunate enough to have their suffering adequately relieved by even state-

of-the-art palliative care. We believe that people should not have to suffer through a prolonged dying

process against their wishes. We are therefore working for dying with dignity legislation that:

allows aid-in-dying to be provided by doctors who are willing to provide it;o for those with terminal or advanced incurable conditions and suffering they find

intolerable;

o for adults who are making a choice which is voluntary, and are competent and wellinformed about the options;

has strict terms and conditions with at least two doctors involved, and ensures there is formal supervision and transparent reporting of the entire process, as exists in

places like Oregon, the Netherlands and Belgium.

We are working in cooperation with MPs who support dying with dignity legislation for the

development, passage and implementation of effective legislation, after community consultation


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END OF LIFE PLANNING DOCUMENTATION

CONTENTS

Summary.............. ..............................................................................................................................3

The Need.......... ..................................................................................................................................4

Document Storage and Accessibility .................................................................................................5

The Will........... ..................................................................................................................................5

Financial Documents .........................................................................................................................6

Expressing your Wishes about Financial Matters (Enduring) Power of Attorney..........................6

Expressing your Wishes about Health and Lifestyle Issues -

Enduring Guardianship and Advance Care Directive........................................................................7

Enduring Guardian.............................................................................................................................8

Advance Care Directive.....................................................................................................................9

Organ Donor ................................................................................................................................10

Funeral arrangements including Funeral Insurance.........................................................................10

Useful websites ................................................................................................................................11

ATTACHMENTS.................................................................................................................................12

Attachment 1 - Simple Form for Listing of Key End-of-Life Documents ..........................................

Attachment 2 - Enduring Power Of Attorney ......................................................................................

Attachment 3 - Enduring Guardian......................................................................................................

Attachment 4 - Advance Care Directive ..............................................................................................

Attachment 5 ....................................................................................................................................

Attachment 5-1: Step by Step Guide to writing an Advance Care Directive (ACD) or appointing

an Enduring Guardian (EG). ................................................................................

Attachment 5-2: Guide to the Role of Enduring Guardian (or Person Responsible).......................

Attachment 5-3: Some Common Questions and Answers...............................................................

Attachment 6 -

..................................................................

Examples of Health Care Directions to Consider for Inclusion in Enduring

Guardianship or Advance Care Directive

Example A - Enduring Guardian or Advance Directive Wishes .....................................................

Example B - Enduring Guardian or Advance Directive Wishes.....................................................

Example C - Enduring Guardian or Advance Directive Wish List.................................................

Example D - Enduring Guardian or Advance Directive Wishes.....................................................

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Acknowledgement

In preparing this document we have received invaluable assistance from the Public Guardian,members of the Palliative Care Clinical Network and other professionals working in the field. We are

very grateful for this help, while acknowledging that any errors or omissions are wholly our

responsibility.

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Summary

There are major advantages to you and the people you care about if you have sensible plans in place

to ensure that your wishes are known and will be followed in a situation where you are not able to

state what you want. More and more health bodies and organisations are promoting better advance

care and end-of-life planning and demonstrating the benefits for individuals and for their familiesand friends.

This booklet and its attachments provide a simple guide to the documents to consider in your end-of-

life planning, how to ensure they are readily available at need and how to ensure that there is no

confusion about who you want to make decisions on your behalf if you are no longer able to act for

yourself.

Key points

It is never too early to get the documentation and organisation right. You never know what lifehas in store and all the legal documents have to be completed while of sound mind.

If you do nothing else, talk to those close to you about what you think and what you would wishin different health and other end-of-life circumstances.

There are advantages in documenting your wishes and it is particularly important where youknow there are differences of opinion within your family.

Each of the key documents you need to consider is described in this booklet. These are mostlylegal documents that need to be properly prepared, signed, witnessed and lodged.

Those that relate to your health care provide for you to state your health care wishes incircumstances where you cannot speak for yourself and for you to nominate one or more peoplewho you would want to act for you in any necessary decisions.

It is very important to think through what your wishes are, to discuss these with the person younominate to act for you and to document them clearly. This booklet includes detailed

suggestions on how to go through this process and issues to consider in choosing a person to act

for you.

When completed, these documents have legal force and must be observed. It is also important to store your copy of these documents in a place where they can be easily

found and to supply copies to relevant people such as your doctor.

Note that much of the legislation to which these notes refer is State based and differs from State to

State. These notes refer to Tasmanian law.

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The Need

It is fair to say that most of us are interested in this subject because of a background fear of an

unnecessarily unpleasant end to our lives. The fundamental objective of this session is to go through

ways of minimising this risk, so that we can focus, as we should, on enjoying life.

Although the taboo against speaking or thinking about death is slowly disappearing, the fact remains

that too many people do not have sensible plans in place to minimise the trauma, inconvenience and

plain muddle that can occur, or to ensure that their wishes are known and will be followed in a

situation where they are not themselves able to state what they want - for example as a result of

trauma or dementia.

It is also unfortunately true that, in our complex modern society, good end-of-life planning requires

each of us to get our minds round a number of legal and quasi-legal documents and provisions. It is

also true that the range of medical procedures available can be quite confusing to the lay-person. The

key to dealing with these complexities is to keep a clear focus on the outcomes that you want and to

be willing to seek advice where you need it. For the vast majority of people relatively simple

provisions will meet their needs and, while there are some horrendous cases of what can go wrong,the likelihood of this happening is very low if we make sensible and simple provisions.

So our first objective in this paper is to provide materials and explanations that can clarify the

requirements and make it as simple as possible to specify your wishes and choices on end-of-life

matters. It also encourages you to identify and nominate the person or persons who will represent

your wishes and look after your business and financial affairs for you if you are unable to do so

yourself.

To start with three key messages:

IT IS NEVER TOO EARLY TO GET THE DOCUMENTATION AND ORGANISATIONRIGHT.

IF YOU DO NOTHING ELSE, TALK TO THOSE CLOSE TO YOU ABOUT WHATYOU THINK AND WHAT YOU WOULD WISH IN DIFFERENT HEALTH ANDOTHER END-OF-LIFE CIRCUMSTANCES.

WHERE THERE IS ANY RISK OF 'FAMILY POLITICS' GETTING IN THE WAYOF OUTCOMES IN ACCORDANCE WITH YOUR WISHES, EXTREME CARE ISNEEDED IN DOCUMENTING YOUR WISHES, CHOOSING THOSE WHO WILLACT FOR YOU AND ANY LIMITS TO THEIR POWER TO ACT IF YOU ARE NOLONGER ABLE TO ACT FOR YOURSELF.

A fourth useful message is to carry with you a means by which your wishes can be identified in an

emergency. The Guardianship Board issues a (free) wallet card. A body called MedicAlert based in

South Australia also (for a modest fee) issues a wallet card and will provide a wristband or necklet

engraved with key data. It is not really necessary to go to the lengths of the gentleman who had his

details tattooed on his chest!

The three key messages above need to be kept in mind when considering all the documents covered

in this paper. There are connections between all of them, so thought may be required to ensure that

they are consistent with each other.

Where all the family understand and agree with your wishes and with each other, the documents canbe simple and straightforward, but particularly where there are serious tensions and disagreements

with or between those closest to you or your heirs, great care and sound professional advice may be

needed.

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The sad fact is that many of us try to put off all forms of paperwork and in particular what appears at

the time to be non-urgent paperwork about something we vaguely hope will not happen and

certainly not yet! It can also be difficult to find the right time to discuss our wishes in the depth

required to ensure that there is full shared understanding. If the worst does happen, the result can be

messy for our loved ones and may also result in us receiving forms of treatment that we don't want.

The other serious risk from delay in an age when we are tending to live longer is that of dementiaovertaking us before we get our end-of-life planning sorted out. All the legal documents have to be

completed while of sound mind and, while the precise stage at which we may be deemed to be not

of sound mind is not entirely clear, it is important to settle our wishes while there is no doubt that we

are of sound mind. It is worth adding that, in law, we are presumed to be of sound mind unless and

until we are professionally diagnosed to be otherwise. Even then, we can be of sound mind for

certain decisions, but not for others. The requirement is that we can fully understand the

consequences of our action or decision.

So what follows is an attempt to make it easier to work out and record your wishes in a timely way.

Document Storage and Accessibility

It is extremely important that your documents should be easy to find. You should hold a copy of all

relevant end-of-life documents in one place and ensure that this place is known to those you want to

have access to them on your behalf. Copies (e.g. of your Will) should be clearly marked with the

location and contact number of whoever holds the original.

If travelling interstate or overseas, it is sensible to carry a reference card with key details (including

contact of a family member/friend nottravelling with you) with or in your passport/wallet.

The Will

It is advisable for a number of reasons to use a lawyer or the Public Trustee to prepare your Will and

to ensure that the lawyer holds the original and you a copy. Your copy should be marked to show

where the original is.

If you have a lot of minor possessions that you want various friends or members of the family to

have it is wise to prepare a list of things not included in the Will and indicate who you want to have

each. While this aims to save potential disagreements, it is important to recognise that such a list is

not a legal statement. In law these things would go to your residuary beneficiary unless that personchooses to distribute them according to your request. It is sensible to hold the list with your copy of

the Will.

If your Will was made over 10 years ago (or whenever there is a major change in your situation) it is

wise to review it to ensure that it expresses your current wishes.

The need for a Will is sufficiently well-known not to require more than a brief mention. There is a

useful document on the Internet at http://www.legalaid.tas.gov.au/factsheets/Wills.html . This

explains, among other things, the events (e.g. marriage or divorce) which invalidate any current Will

so that a new one must be made.

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Financial Documents

It is important to keep a simple document with your end of life documents, stating the name and

contact or location of your:

bank(s) financial adviser/stock broker (or where your investments are held) superannuation provider pension details insurance policies (life, funeral, endowment etc) title to your house, and any other relevant details needed to ensure that your financial affairs can be dealt with

efficiently.

Other important contact information is a list of who needs to be notified of your death (both business

and personal, including for example your GP, your clubs and church as well as bodies such as the Tax

Office.) See Attachment 1 for a simple form for listing these matters.

Expressing your Wishes about Financial Matters (Enduring) Power of Attorney

A Power of Attorney provides for someone to handle your financial and business affairs (whether

temporarily or permanently) if for any reason you become unable to so. It is usually prepared for

you by a lawyer or other professional with your agreement. It is safe (and wise) to complete one

ahead of need. The powers are only activated when needed. It is important to distinguish between a

temporary power useful for example when travelling overseas or having an operation that will

leave you unable to act for yourself for a period from an Enduring Power of Attorney, which comes

into effect when you are unable to act for yourself and 'endures' until the end of your life or until you

recover and rescind it.

It is worth noting that there are arrangements that will reduce the need to prepare a Power of

Attorney. The most important of these is if your financial affairs are in joint names, with either to

sign. However, even then, it is necessary to remember that you may need back up arrangements, for

example if travelling overseas, and that the situation may need review in the case of serious illness or

disability of one of the joint signatories.

Power of Attorney is completely distinct from the Enduring Guardianship (below) and the

person who holds your Power of Attorney can be but need not be the same person as your Enduring

Guardian. It is critical that the person (or persons) you choose is one whom you completely trust to

act as you would wish. This is usually a family member, but possibly a close friend or a lawyer or

other professional you know well. It is wise that there should be a trusted legal or financialprofessional available in support if the holder of the power is not him/herself a professional. (As an

example, the power may be held by a relative and the family solicitor jointly, with the solicitor

instructed to act in accordance with the directions of the relative where the action depends on an

understanding of your wishes (such as a move from one care home to another), subject to legal

considerations.)

There are forms for different purposes (e.g. temporary or permanent) of which one, the General

Enduring Power of Attorney (Form 4), is most commonly used. For those most commonly needed

see Attachment 2.

Website: http://www.dpiw.tas.gov.au/internnsf/WebPages/MPHS-8CSV76?open

This is probably the best page for an overview of the different forms of power of attorney and how

(and in what circumstances) to complete them.

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Expressing your Wishes about Health and Lifestyle Issues -

Enduring Guardianship and Advance Care Directive

While Power of Attorney applies to financial or business matters, Enduring Guardianship (EG) and

Advance Care Directives (ACD) apply to medical and lifestyle matters. EG is provided for inTasmanian State legislation, the Guardianship and Administration Act 1995. ACD forms are used by

many health care organisations (a few still use the term Statement of Wishes rather than ACD).

Although a standard ACD form is increasingly being adopted, a variety of ACD forms continue to be

used by different organisations.

These are two ways of setting out your treatment wishes in different circumstances so that medical

and other staff can better plan and respond to your needs in a way that you would prefer. Both

methods enable you to express your treatment wishes.

The two essential differences between these two approaches are:

1. The EG involves appointing a person or persons who have the legal power to make decisionsconsistent with your expressed wishes if you are unable to express those wishes yourself. No

such person is appointed for an ACD. If you have an ACD but no Enduring Guardian and are

unable to speak for yourself, the people who have the right to specify what treatment you

would or would not accept are in order of legal priority:

a guardian (including an Enduring Guardian) who has the power to consent to health care,which includes the power to refuse or withdraw consent to treatment

a spouse - including a de-facto spouse an unpaid carer who is now providing domestic services or support to the patient, or who

provided these services and support before the patient entered a residential facility, or

a relative of friend who has both a close personal relationship and a personal interest inthe patients welfare,

unless someone is specified as the Person Responsible or specifically excluded by the Person

Concerned in the EG or ACD form.

2. The EG, being prepared under specific legislation, is statutory law, whereas all forms of ACDare what is known as common law documents. Any problems of interpreting or applying an

EG are dealt with by the Guardianship and Administration Board, while any issues of

interpreting or applying an ACD must be dealt with by a Court.

The fact that the two processes are different and that it is not entirely clear which would have

precedence in case of a clash simply highlights the importance of ensuring that the two documents (if

you have both) are entirely consistent with each other. (However, if circumstances arise which make

some of the EG conditions inappropriate while a newer ACD has conditions more appropriate to your

current situation, it may be possible for your Enduring Guardian to apply for the ACD rather than the

EG to be followed.) If you have previously completed an EG (or an ACD) it is very important that

any institution requiring that you also complete an ACD is aware of your EG and that the new ACD

is completed in accordance with any wishes expressed in your EG. Staff should be able to assist you

with this.

The situation is somewhat complicated if you regularly travel interstate. The law in Australia is

currently State based and the laws and the terms used differ from State to State, which is rather

unsatisfactory, but likely to continue. The EG form, being a State based statutory law document,

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may not be recognised in other States. There is some mutual recognition between States but the

situation is complex. However, the ACD, being a common law document, wouldbe recognised in

other States, though it may be necessary to go to Court to have it recognised. It is probable that the

statement of wishes section in your EG form would also be recognised interstate as a common law

document, though your Enduring Guardian may not have power to act on your behalf.

If you regularly spend time in another State, it may therefore be wise to also express your wishes inthe terms required by that State and also to prepare an ACD in addition to your Tasmanian EG

document. You can access documents that apply in other States from the useful website

YourLastRight.com in the section below. The situation is much more uncertain when travelling

overseas, but carrying a copy of your ACD or EG with you will, at minimum, inform carers of your

wishes.

Both the EG and the ACD are ways of expressing your legal right to specify what medical support or

intervention you will or will not accept if you suffer illness or accident. The EG does not require that

you complete the section in which you express these wishes, but we very strongly recommend that

you do so. ACD forms are designed specifically to record your wishes in regard to medical support

or intervention.

Deciding your wishes requires careful thought and discussion, with your Enduring Guardian if you

appoint one and, where possible, with your family or close friends. It is not necessary to go into a lot

of medical detail about specific treatments you will or will not accept as long as your statement

makes your wishes clear. Examples A and C in Attachment 6 are examples of 'plain language'

statements, while Example B contains a number of specific statements about medical treatments.

Example D is a listing of possible conditions from a book.

Enduring Guardian

Under present circumstances, our strong recommendation is that you appoint an Enduring

Guardian and include a statement of your wishes regarding treatment within the document

that appoints your Enduring Guardian.This of course depends on there being a suitable person

who you are willing to appoint and who will accept the appointment. For example, you may have

no family or they may disagree with your views and it may be difficult to find a suitable friend to

take the role. Unfortunately, under current law the Public Guardian can not act for an individual and,

where an Enduring Guardian cannot be found, it is necessary to rely on a very carefully worded

ACD. This should provide good protection, particularly if you specify by name any person who

might otherwise have a say in your treatment but who you wish to have specifically excluded from

this role.

The process and form for appointing an Enduring Guardian is completely distinct from the Power of

Attorney above and the Enduring Guardianship form must be lodged with the Guardianship and

Administration Board for it to be valid. If you decide to change it, you must withdraw the old

form before lodging the new one. The Board will file the original and send you a copy. You need to

also make copies for your patient file with your GP and any treating specialist, for your Enduring

Guardian and also one that you can take with you if you go into hospital or an aged care facility.

Attachment 3 has a copy of the form and accompanying information sheet. More details including

copies of forms and a Handbook are available from the website,

http://www.guardianship.tas.gov.au/about_us#aboutusEG Your Enduring Guardian is a person you appoint to make your personal or medical decisions if you

should lose the ability to decide for yourself because of a disability. It is therefore very important

that you are sure that the person you appoint is in sympathy with your own wishes for your care,

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particularly in the final stages of your life. Once you have worked out and made a note of your

wishes, it is very important to allow plenty of time for detailed discussion with the person you

intend to appoint to ensure that you both share the same understanding of your wishes and the

appointee is comfortable with them. It is also important that the person you appoint understands

the responsibility that they have accepted, which may involve making difficult decisions, and is also

prepared, if necessary, to be calmly assertive in dealing with professionals. It is an unfortunate fact

that there are still a very few professionals who regard their own views as more compelling thanthose of their patient. In situations of conflict it is possible to go to the Public Guardian for

resolution. It is also possible to go to the Medical Council if a doctor refuses to follow directions in

the EG form.

You can appoint both a primary and an alternative Enduring Guardian. If you are becoming elderly, it

would be desirable for at least the alternative guardian to be of a younger generation. For example

many people appoint their spouse as primary Guardian and a child or younger close friend as

alternative Guardian. If you have nominated only one guardian and that person pre-deceases you or

leaves the State, it will be necessary to complete and lodge a replacement EG form.

Taking on the role of Enduring Guardian is a substantial responsibility and the process of decidingyour wishes, selecting your Enduring Guardian and your Enduring Guardian understanding the

issues that may arise should be undertaken thoroughly and carefully. Attachment 5 contains

detailed advice on the process and the issues that may be encountered in acting as Enduring

Guardian.

Advance Care Directive

An increasing number of hospitals, retirement homes, palliative care centres and similar institutions

are making use of a form of Advance Care Directive, essentially a form that sets out your treatment

wishes in case you are unable to make decisions for yourself at the time when treatment is needed. Anew ACD form is being developed by a working party of the Tasmanian Palliative Care Clinical

Network, and the Clinical Ethics Committee of the Southern Tasmania Area Health Service. In time

this may become the one that is used more consistently by different facilities and services.

Attachment 4 contains a copy of the first version of this Advance Care Directive. You can also

access it from the website of the Department of Health and Human Services -

https://clinicalnetworks.dhhs.tas.gov.au/download/attachments/11337953/Advance+Care+Directive.p

df?version=1&modificationDate=1299460109727

A person accessing these services or institutions may be asked to complete such a form with the

assistance of staff. To reiterate, the forms may differ between services but all cover the same broad

set of issues.

We stress again that, if you have stated your wishes in the form of an EG, it is very important that

anyone wishing you to complete an ACD is aware of this and any wishes expressed in the ACD be

fully consistent with those in the EG (or a new EG prepared if the ACD is a more accurate statement

of your wishes). The new ACD referred to above includes a section for you to include information

about your Enduring Guardian. Make sure that a copy of the EG form is filed with the new ACD.

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An important point is that completion of an ACD, unlike the EG, does not require that you appoint a

person who is authorised to make decisions on your behalf when you cannot do so, although the

ACD form included in this booklet has provision for you to do so if you wish. Appointment of such

a person increases your assurance that your wishes will be followed, particularly in situations where

there is some doubt about the best course of action.

It is worth noting that you do not have to use any prepared form. Any clear statement of yourwishes, if properly signed, witnessed and dated, has the same force as an ACD on a prepared form. If

you are unable to complete an ACD, the form can be completed on your behalf, but the risk is that

they may not accurately reflect your wishes if this is done.

It is also worth noting that a hospital to which you may need to be admitted at some time is prepared

to create a record with your ACD or EG even if you have never had an admission.

Organ Donor

It is increasingly common for people to enrol as organ donors. However, under current practice, it isopen to relations after your death to countermand your wish to make your organs available. You may

want to include your wishes in your Enduring Guardian form, which would strengthen the hand of

your Enduring Guardian to see that your wishes are carried out.

An organ donor form is included on all Medicare claim forms. It only needs to be completed once

and will be held on your file by Medicare.

Note that, if you wish your organs to be available after your death, it may be medically necessary for

short term life support to be provided while arrangements are made. You may wish to give

permission for life support for this purpose, even if you reject continuing life support as part of the

care you receive.

In addition, the University of Tasmania Faculty of Health Science runs a Body Bequest Program

through which people can donate their body to sciences. Details and forms are available at

http://www.utas.edu.au/medicine/quick-links/body-bequest-program

Funeral arrangements including Funeral Insurance

If you have strong views about funeral arrangements, it may be wise to record them with your other

documents.

Funeral insurance has been strongly promoted by some companies. An article in Choice Magazine

for February 2011 questions the value of funeral insurance for most people. It suggests that either

paying a lump sum for a pre-paid funeral or paying premiums similar to those you would otherwise

pay for funeral insurance into life insurance are both likely to be a better choice for most people.

(Choice Magazine most recently examined life insurance in March 2010).

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Useful websites

Dying with Dignity Tasmania (Inc) http://www.dwdtas.org.au/

The site includes advice on completion of an Enduring Guardian form and a wealth of material

relating to the organisation and issues concerning end of life. It lists related organisations in other

States

YourLastRight.com http://www.yourlastright.com/

The body is the peak organisation for State and Territory dying-with-dignity and voluntary

euthanasia societies.

The site includes a listing of where Australian politicians stand on voluntary euthanasia. It also gives

guidance on how to find the end of life planning requirements and choices in other States.

Power of Attorney http://www.dpiw.tas.gov.au/internnsf/WebPages/MPHS-8CSV76?open

This is probably the best page for an overview of the different forms of power of attorney and how

(and in what circumstances) to complete them.

See also http://www.publictrustee.tas.gov.au/article.php?Doo=ContentView&id=660 for information

about when the power begins to operate.

Enduring Guardianship http://www.guardianship.tas.gov.au/about_us#aboutusEG

The body administering this legislation is part of the Guardianship and Administration Board. The

site listed gives a brief description and links to the appointment form and related documents.

The Victorian office of the Public Advocate has an extremely detailed guide to power of attorney and

guardianship in Victoria at http://www.publicadvocate.vic.gov.au/publications/121/

Advance Care Directives

https://clinicalnetworks.dhhs.tas.gov.au/download/attachments/11337953/Advance+Care+Directive.p

df?version=1&modificationDate=1299460109727

http://www.justice.qld.gov.au/__data/...file/.../advance-health-directive.pdf

Insurance (and a variety of other subjects of interest) http://www.choice.com.au/
http://www.dwdtas.org.au/http://www.dwdtas.org.au/http://www.yourlastright.com/http://www.dpiw.tas.gov.au/internnsf/WebPages/MPHS-8CSV76?openhttp://www.dpiw.tas.gov.au/internnsf/WebPages/MPHS-8CSV76?openhttp://www.publictrustee.tas.gov.au/article.php?Doo=ContentView&id=660http://www.guardianship.tas.gov.au/about_us#aboutusEGhttp://www.guardianship.tas.gov.au/about_us#aboutusEGhttp://www.publicadvocate.vic.gov.au/publications/121/https://clinicalnetworks.dhhs.tas.gov.au/download/attachments/11337953/Advance+Care+Directive.pdf?version=1&modificationDate=1299460109727https://clinicalnetworks.dhhs.tas.gov.au/download/attachments/11337953/Advance+Care+Directive.pdf?version=1&modificationDate=1299460109727https://clinicalnetworks.dhhs.tas.gov.au/download/attachments/11337953/Advance+Care+Directive.pdf?version=1&modificationDate=1299460109727http://www.justice.qld.gov.au/__data/...file/.../advance-health-directive.pdfhttp://www.choice.com.au/http://www.choice.com.au/http://www.justice.qld.gov.au/__data/...file/.../advance-health-directive.pdfhttps://clinicalnetworks.dhhs.tas.gov.au/download/attachments/11337953/Advance+Care+Directive.pdf?version=1&modificationDate=1299460109727https://clinicalnetworks.dhhs.tas.gov.au/download/attachments/11337953/Advance+Care+Directive.pdf?version=1&modificationDate=1299460109727https://clinicalnetworks.dhhs.tas.gov.au/download/attachments/11337953/Advance+Care+Directive.pdf?version=1&modificationDate=1299460109727http://www.publicadvocate.vic.gov.au/publications/121/http://www.guardianship.tas.gov.au/about_us#aboutusEGhttp://www.publictrustee.tas.gov.au/article.php?Doo=ContentView&id=660http://www.dpiw.tas.gov.au/internnsf/WebPages/MPHS-8CSV76?openhttp://www.yourlastright.com/http://www.dwdtas.org.au/


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ATTACHMENTS

12


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Attachment 1 - Simple Form for Listing of Key End-of-Life Documents


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TO NOTIFY ON MY DEATH

Name Contact

Lawyer (or holder of original of Will)

Bank

Bank

Bank

Financial Adviser (or where shares etc listed and held)

Superannuation/pension provider

(and other pension details and contacts)

Insurance policies (life, endowment, funeral etc)

Location of House Title (and other key ownership documents)

Other people to notify (e.g. relations/friends, GP, Centrelink, clubs, church, Tax Office)

Health Directives (Enduring Guardian, Advanced Health Care) and where copies are kept.

Other comments (e.g. preferred funeral arrangements)


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Attachment 2 - Enduring Power Of Attorney

An extract of key explanations and forms from the website

http://www.dpiw.tas.gov.au/internnsf/WebPages/MPHS-8CSV76?open is included on the following

pages.

NOTE

Enduring Power of Attorney is concerned with your business and

financial affairs, not with your health care wishes. The holder of your

Enduring Power of Attorney need not be the same person as your

Enduring Guardian (see Attachment 3).
http://www.dpiw.tas.gov.au/internnsf/WebPages/MPHS-8CSV76?openhttp://www.dpiw.tas.gov.au/internnsf/WebPages/MPHS-8CSV76?open


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Attachment 3 - Enduring Guardian

A copy of the form and examples of conditions included are set out on the following pages.

Note that if there is no Enduring Guardian and no Advance Care Directive, medical professionals

will consult (where possible) with your spouse, unpaid carer or relatives and will follow the course of

treatment they believe to be best suited to your condition and known wishes.

DOCUMENTS FOLLOW

1. Enduring Guardianship infosheet2. Instrument Appointing Enduring Guardian(s)

NOTE: Our current recommendation is that you complete an

Enduring Guardianship, with a full statement of your end-of-life

health care wishes, whether or not you also complete an Advance

Care Directive (see Attachment 4). The examples shown in

Attachment 5 may help you in framing your wishes.

Some services and facilities require completion of an Advance

Care Directive when you access them. If so, you need to make

sure that: they receive a copy of your Enduring Guardianship form, the Advance Care Directive is completely consistent with the

Enduring Guardianship provisions, and

that the institution has the name and contact details for yourEnduring Guardian.


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What is an enduring guardian?

An enduring guardian is a person you appoint to make your personal or

medical decisions if you should lose the ability to decide for yourselfbecause of a disability.

As adults, we can choose where we live, whom we see or visit, what medical

treatment we want, and what services we will have.

Generally, if a person loses ability to make decisions, decisions are still made by familyor carers. Usually these arrangements work well, completing and registering thisdocument will give you certainty regarding the person who makes decisions for you.You may also want to ensure that your wishes are known and followed. It is wise tochoose someone you trust who will be decisive and who will be a good advocate foryou.

Under Tasmanian law, even if you have granted someone Power of Attorney, he or she

cannot make your medical decisions. In Tasmania a Power of Attorney only relates to

your financial estate.

The appointment of your enduring guardian takes effect only if you becomeunable to make your own medical or personal decisions. Your enduring guardiancan then communicate your wishes on your behalf after you have lost the ability to

communicate.

What decisions would my enduring guardian make?

Your enduring guardian would make your medical and lifestyle decisions.These could include what medical treatment you have, whether you live in your own

home or a nursing facility. He or she could decide who visits you and what personal

services you receive, such as home support or meals on wheels.

Your enduring guardian is legally bound to: Follow your specific directions.

Act in your best interests. Ensure that decisions about your life promote your dignity

and freedom as

much as possible.

Enduring Guardianshipinfosheet


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Conditions.

You may include particular decisions about your medical care or lifestyle on the form

when you appoint your enduring guardian. These are called conditions. You do nothave to include any conditions if you do not want to.

You can write your conditions in your own words. As long as your conditions are

clear, lawful, and practically possible to carry out, they are binding on your enduringguardian and must be respected.

Here are some examples of conditions: Idirectmyguardiantoconsultmyfriend(name)onanyimportantdecisions

about my health and welfare.

IfIrequirelong-termcareinafacilityoutsidemyhome,Iwouldprefertolive

closetomybrother,(name).

Whenmyguardianassumeshisorherrole,Idirectmyguardiantonotifymy

relative(name,address)ofthenatureofmyillness.

BecauseofmyreligiousbeliefsIdonotwishtoreceiveabloodtransfusionor

blood products under any circumstances.

Iwouldlikelife-prolongingtreatmentstobecommencedandcontinued,

includingCardioPulmonaryResuscitation(CPR),whiletheyaremedically

appropriate and remain in my best interests.

IfIamacutelyillandunabletocommunicateresponsivelywithmyfamilyand

friends and it is reasonably certain that I will not recover, I want to be allowed

to die naturally and to be cared for with respect for my dignity. I do not want to

be kept alive by extraordinary or overly burdensome treatments that might be

usedtoprolongmylife.Ifanyofthesetreatmentshavebeenstarted,Irequestthat

they be discontinued. However, I do want palliative care that includes

medications, and other treatments to alleviate suffering and keep me comfortable,

and to be offered something to eat or drink.

Idirectmyguardiantoarrangeforapriestof(myreligion)toattendtomeona

regular basis.

Iamaregisteredorgandonorandwouldliketodonatemyeyes,liverandany

other organs that can be used.

Whenmyguardianassumeshisorherrole,Idirectmyguardiantoadvisemy

lawyer of my condition so that they may arrange for my Power of Attorney to

take effect.


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Who can I appoint as my enduring guardian?

You can appoint anyone over the age of 18. Most people choose a relative or close friend

whom they trust.

You have four options for choosing people. You can:

1. Appoint one person. For example, your spouse.

2. Appoint a first guardian, and name an alternative guardian in case your firstguardian cannot assume the role. For example, you could appoint yourhusband, and if he was not able to act as your guardian for any reason, you could name

your son as your alternative guardian.

3. Appoint joint guardians. Joint guardians must agree on any decision theymake. It is important if you select joint guardians that they are willing to work

cooperatively. Joint guardians can however work jointly or severally. Disputes between

jointguardianswillberesolvedbytheGuardianshipandAdministrationBoard.

4. Appoint an alternative guardian for any of your joint guardians. The enclosed

form is not suitable for this. You can draft your own form or seek legal advice.

Can I change my mind?

Yes. You can revoke your appointment of an enduring guardian at any time, and appoint

someone else if you wish, as long as you have the capacity to understand what you are

doing. You can add conditions or change your mind about what conditions you make, but

you must fill out and register a new document to do this.

What factors should I consider?

Beforeyouappointanenduringguardian,considerthesefactors.

Who would I trust most to make my medical decisions? Consider who knowsyou and your preferences best. Think about whether you want to appoint one person, one

person and an alternate person, or two or more people who must agree on your decisions.

It would be best to select a person whom you know to be a good decision maker and a

good advocate.

Will the person(s) feel comfortable about being appointed as my guardian(s)?Talk to the person or persons you would like to appoint before you fill out the form.Show them this infosheet so that they understand what they would need to do. Discuss

with them your conditions and how you want them to be interpreted.

Is there anyone I would want my guardian to consult? Your guardian will have thefinal decision, but you may want to direct them to consult specific members of your family

or friends and take their views into account.

Are there any decisions I want to make in advance? Think about the types of careand medical treatment you would want and the types you would not want.If there is medical treatment you would not want, you may decide to explain this to your

family now.


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Once you have considered these factors, you are ready to fill out the Enduring

Guardianship form enclosed with this info sheet.

How do I make this legally binding? You must register this document with the

GuardianshipandAdministrationBoardinorderforittobevalid.Youmaypostit

totheBoardatGPOBox1307,Hobart7001.Onceyouregisteryourappointment,

itisapublicdocument.TheGuardianshipandAdministrationBoardwillenteryour

appointment in its records and return copies of your document to you. You will alsoget a wallet card to carry with you.

Why does the Board send me more than one copy of my registeredinstrument? It is a good idea to give a copy of the instrument to your guardian, to

your usual doctor, and to anyone else you may wish to know about the instrument.

If you have regular contact with a hospital you should also give the hospital a copy.

What if I am away from Tasmania when my enduring guardian needs to

act? In some states and territories, interstate guardianship appointments are legallyrecognised and your enduring guardian will be able to act. In other cases, yourguardian may need to contact the local guardianship board or tribunal.

What if my enduring guardian does not act in my best interests? If your

enduring guardian is incompetent, negligent or acts contrary to your best interests,

apersonmayapplyfortheGuardianshipandAdminstrationBoardtoreviewthe

appointment and revoke it if necessary.

Want more information?

Free legal advice is available between 9am and 5pm

MondaytoFridayon1300366611

If you would like more copies of this kit or form, visit any

Service Tasmania shop or phone the Guardianship and

AdministrationBoardon62333085ordownloadacopy

from www.guardianship.tas.gov.au/publications


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Guardianship and Administration

Act 1995

Form1(Section 32(2)(a) and (b)

Instrument Appointing Enduring Guardian(s)For Tasmania

Write your name,address, occupationand date of birthhere.Occupation examples:Carpenter; Retiree;Home duties

Section 1: Your details

Write your guardiansdetails here.If you only want to appointone person as your guardian,complete this section, thengo to Section 3. If you wantto appoint joint guardians,write the first guardians

details here.

Section 2: Choosing your guardian(s)

If you want to appointjoint guardians, writethe second personsdetails here. See theinfo sheet for moreinformation on joint

guardians.

Optional section:

Optional section:If you want to appointan alternative guardianin case one of yourguardians cannotassume the role,

write your alternativeguardians details here.If you do not wish toappoint an alternativeguardian, go to Section4 now.

Section 3: Choose your alternativeguardian (Optional)In the event that my guardian (or one of my joint guardians) becomes

incapable or unavailable to exercise this appointment, I appoint

I, (your full name):

Of (your address)

Occupation:

Date of birth:

Phone No.:

Appoint (guardians name):

Of (guardians address):

Phone No.:

Guardians occupation:to be my guardian.

I also appoint (joint guardians name):

Of (joint guardians address):

Phone No.:

Joint guardians occupation:

to be my guardian.

(Alternative guardians name):

Of (alternative guardians address):

Phone No.:

Alternative guardians occupation:


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Optional section:If you want to givespecific directions toyour guardian,writeyour own decisionsabout your medical

care or lifestylehere. These are calledconditions.

If you need more space,add a separate sheet andsign and date it at thebottom of the page.

See the info sheet forexamples of conditions

and how to write them.

If you do not imposeany conditions, aguardian will have fullpowers should you losecapacity.

I require my guardian to observe the following conditions in exercising,

or, in relation to the exercise of, the powers conferred by this

instrument:

Section 4: Conditions uponappointment

By executing this instrument appointing an enduring guardian, I hereby

revoke any and all former instruments made by me which appoint any

enduring guardians or alternative guardians and such instruments shall

cease to have effect upon the registration of this instrument made by

me pursuant to Part 5 of the Guardianship and Administration Act 1995.

Subject to any conditions specified below in Section 4, I authorise my

guardian, in the event that I become unable by reason of a disability

to make reasonable judgments in respect of matters relating to my

personal circumstances to exercise the powers of a guardian under

Section 25 of the Guardianship and Administration Act 1995.


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You sign here, butbefore you sign, youmust arrange for twowitnesses to watchyou sign this form.The witnesses cannot berelated to you or yourguardian, or be people

whom you have namedas guardians.

Section 5: Signatures

Signed:

Date:

This is an appointment of an enduring guardian made under Part 5 of

the Guardianship and Administration Act 1995. I acknowledge that this is a

public document and is available for public scrutiny.

Signed:

Name:

Address:

Your first witnesssigns here, and writestheir full name andaddress.

Signature of witness 1

Your second witnesssigns here, and writestheir full name andaddress.

Signed:

Name:

Address:

Signature of witness 2

As witnesses we certify that (a) the person has signed this instrument

freely and voluntarily in our presence;

and

(b) the person appears to understand the

effect of this instrument.


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Your first guardianwrites their fullname and signs hereto say they accept theappointment as yourguardian. This should bethe person whose nameyou wrote on the firstpart of Section 2. They

do not need a witnessfor their signature.

I, (guardians name):

accept appointment as guardian under this instrument and undertake

to exercise the powers conferred honestly and in accordance with the

provision of the Guardianship and Administration Act 1995.

Signed:

If you have appointedtwo joint guardianswho must act together,your joint guardianwrites their full nameand signs here. They donot need a witness fortheir signature.

If you have appointedan alternativeguardianin case yourfirst guardian cannotassume the role, youralternative guardiansigns here. They do notneed a witness for their

signature.

How to register this form

Step 1: Ensure you have signed the form in front of two witnesses

who must also sign the document. The proposed guardians

must also sign the document.

Step 2: Mail this form to:

Guardianship and Administration Board

GPO Box 1307, Hobart Tas 7001

Step 3: The Board will register the document and send you copies for

yourself, your enduring guardian and your family doctor.

You may wish to make extra copies for other members of

your family, hospitals and your lawyer.

Note: This document is not legally binding unless it is registered at the

Guardianship and Administration Board.

I, (joint guardians name):




Signed:

I, (alternative guardians name):




Signed:


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Attachment 4 - Advance Care Directive

An example of an Advance Care Directive follows. Note that a number of organisations usesomewhat different forms and collect them or have them completed in different ways.

The form and accompanying notes are useful as a guide to thinking about what you might want in

different circumstances.

DOCUMENT FOLLOWS

1. Advance Care Planning Fact Sheet and Form

NOTE: Under current circumstances we strongly recommend that

you rely primarily on an Enduring Guardianship to record your

end-of-life health care wishes. Any Advance Care Directive that

you complete should be completely consistent with the wishes

stated in your Enduring Guardianship.

The examples in Attachment 6 may be useful in deciding your own

wishes.


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ADVANCECAREDIRECTIVE

FORCAREATTHEENDOFLIFE(TASMANIA)INTRODUCTION

Advance care planning is a process of planning for future medical and other health care decisionsin case you ever had an accident or were too ill to make or communicate these decisions yourself.You can do this either by making written instructions or by appointing a person to speak for you,or you can do both. The written instruction document is often referred to as an Advance CareDirective (ACD).

The attached ACD form can also be used by a Person Responsible to write down

instructions for the care of someone who already lacks the ability to do this forthemselves. The Person Responsible should know the person well enough tounderstand what treatment would be best for them.

You can include in your ACD any aspects of care that you identify as important, and in particular,nominate any specific treatments or outcomes that you wish to avoid. This ACD is mainlyfocused on End of Life care, as many people are concerned about being subjected to life-prolonging medical treatment, including life support measures and resuscitation that they wouldnot want when death is thought to be imminent and inevitable. You can specify that you wishinstead to receive appropriate palliative care that primarily addresses comfort and dignity.

You can also make plans for where and how you wish to be cared for, and to help those close toyou at this time.

There is also a section where you can make specific directions about medical treatment at anytime, regardless of whether you are thought to be dying or not, and a specific one for dementia.

It is important that you discuss your values and beliefs and the content of this Advance CareDirective with significant persons such as your proposed Enduring Guardian, your family and closefriends, as one of them will need to be designated as your Person Responsible if you lack capacityto make or communicate decisions for yourself. Under Tasmanian law only an adult, (over theage of 18), can complete a written advance care directive, appoint or be, an Enduring Guardian, orPerson Responsible

This form is designed so that you can keep your own copy of your ACD with the information, andthe ACD form itself can be copied separately so you can give a copy to those people you wish to

have one.

If you need assistance in completing this document or would like more information please contact the

person who gave you this form, your GP or community health nurse, or another health care professional.

1

ACD Version 6 22/12/10

ADVANCECAREDIRECTIVEFORCAREATTHE

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ASMANIA)


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APPOINTING A PERSON TO SPEAK FOR YOU

Explaining Person Responsible and Enduring Guardian

Person Responsible

If you lack capacity (have impaired decision making ability), any medical decisions that need to bemade will be made by a Person Responsible as determined by the Guardianship and Administration

Act 1995. This Act lists those who can make decisions on your behalf in the following order:1. A guardian (including an Enduring Guardian) who has the power to consent to

health care, which includes the power to refuse or withdraw consent to treatment;

2. A spouse - including a de-facto spouse;3. An unpaid carer who is now providing domestic services or support to you, or who

provided these services and support before you entered a residential facility; or

4. A relative or friend who has both a close personal relationship and a personalinterest in your welfare.

It is the responsibility of the medical practitioner recommending treatment to determine whethera person qualifies as the patient's Person Responsible. If the medical practitioner cannot decidebetween competing persons, the matter should be referred to the Guardianship andAdministration Board. You can assist by giving a list of possible persons responsible for you bypreparing an Advance Care Directive. This Advance Care Directive will help the PersonResponsible available at the time to carry out your wishes.

Enduring Guardian

To appoint an Enduring Guardian you require a specific form from the Guardianship andAdministration Board, (see back page for details) An Enduring Guardian can make decisions on

your behalf ONLY if you are not able to make or communicate decisions yourself. Your EnduringGuardian must be at least 18 years of age and mentally competent to make these decisions. Youmay choose to appoint one Enduring Guardian, Joint Enduring Guardians and/or an alternateEnduring Guardian. Your alternate Enduring Guardian will only make decisions for you if yourprimary Enduring Guardian/s is unavailable, or incapable of making decisions.

Your Enduring Guardian is not authorized to make financial decisions for you, as this is the role ofan Enduring Power of Attorney. When selecting someone to be your Enduring Guardian, it isimportant to choose someone who:

You trust and who knows you well;

Is willing to respect your views and values; and Is able to make decisions under circumstances that may be difficult or stressful.

Often a family member is a good choice as an Enduring Guardian, but not always. Make sure thatyou choose someone who will closely follow what you want and will be a good advocate for you.Two witnesses must sign the Enduring Guardianship form. By law your nominated EnduringGuardian cannot also be a witness to your Enduring Guardianship form.

A more informal way to nominate someone to speak on your behalf is to simply name them inyour Advance Care Directive, though you should discuss your wishes with them beforehand.

2



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ADVANCE CARE DIRECTIVE

FOR CARE AT THE END OF LIFE (TASMANIA)

This ADVANCECAREDIRECTIVE will be used to guide future medical decisions ONLY when you lose theability to make or communicate your medical treatment decisions yourself. In this event, your PERSONRESPONSIBLE will make medical treatment decisions on your behalf, in consultation with the treating

doctors responsible for your care at the time. Medical treatment decisions will be made taking intoaccount your expressed wishes, and where these are not known, in your best interests.

If a person lacks the capacity to understand and complete this form for themselves it may becompleted by their legally appointed Enduring Guardian or by a Person Responsible.Where possible the Person Responsible does so in of knowledge of the expressed wishes ofthe Person Concerned before they lost capacity, or in what are believed to be the bestinterests of the Person Concerned.

Where I/my is shown in this document, it means the Person Concerned

THIS IS THE ADVANCE CARE DIRECTIVE FOR ____________________________________

of _________________________________________________________________ (address)

AND IS BEING COMPLETED BY _________________________________________________

I request that the stated wishes for End of Life Care and medical care generally, recorded below, arerespected by my PERSON RESPONSIBLE, and by any doctors involved in my care.

MY VALUES AND BELIEFS (you may wish to make general comments about your values here, orstate any specific religious or spiritual practices to be observed):

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

3


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TTHE

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PLANS FOR LIMITATION OF MEDICAL TREATMENT AT THE END OF MY LIFEI

I request that treatment aimed at prolonging life be withheld or stopped, and appropriate palliative care(for comfort and dignity) be provided, if, at some future time, it is the opinion of the treating teamresponsible for my medical care that:

significant recovery is highly unlikely, and I am therefore dying (death may be expected within thenext few days); or

the outcome of such treatment would be a permanent coma (or vegetative state) orcontinuingprogressive severe dementia; or

any other state that is unacceptable to me (list below).State any other results of treatment or types of treatment that would be particularly unacceptable to you:(e.g. I never want another operation, OR I fear being unable to speak and move myself, OR I do not everwant to be put on a breathing machine, OR I do not want to be fed through a tube.)

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

PLANS FOR MEDICAL TREATMENT GENERALLY WHEN I AM NOT DYING

Other requests with regard to my medical care generally, such as circumstances in which I do or do notwant a particular treatment (for example, an operation for a fractured hip).

_______________________________________________________________________________

______________________________________________________________________________________________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

Any Specific directions should I develop DEMENTIA/ALZHEIMERS DISEASE

______________________________________________________________________________________________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

4


ADVAN

CECAREDIRECTOVEF

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FLIFE(TASMANIA)


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Other wishes:

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

If there is not enough room to write all your requests and wishes, please attach further pages as necessary.All additional pages need to be signed, dated and witnessed.

Name of Person Completing this Advance Care Directive ________________________________

Address ____________________________________________________________________

Signature: ________________________________________ Date: ______________________

Relationship to the person whose Advance Care Directive this is: __________________________

Witness

It is assumed that a witness acts in good faith, and must:

Be over 18; Be unrelated to the PERSON CONCERNED, and must not be a known beneficiary in that

persons will;

Confirm the identity of the PERSON CONCERNED and/or PERSON RESPONSIBLE Believe that the person understands that this document is about medical treatment decisions

and

Be confident that the person is under no duress or pressureThe witness can be a registered health care professional, but cannot be a paid personal carer.

Witness signature: _____________________________________ Date:___________________

Witness name, address and contact details ___________________________________________

___________________________________________________________________________

___________________________________________________________________________If you are registered as an organ or body donor, you may wish to attach your documentation to thisplan.

5

ADVANCECARED

IRECTIVEFORCAREAT

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I(write name here) _____________________________________________ havetalked to, and given a copy of this Advance Care Directive and End of Life wishes to thefollowing people and wish them to speak on my behalf should I not be able to understand orspeak for myself:

Enduring Guardian

Name: _____________________________

Telephone: ___________________ (Home)

____________________________ (Mobile)

____________________________ (Work)

Relationship: _________________________

Date appointed: ______________________

Joint Enduring Guardian

Name: _______________________________

Telephone:______________________ (Home)

_____________________________ (Mobile)

______________________________ (Work)

Relationship: __________________________

Date appointed: ________________________

1. Alternate Enduring GuardianName:______________________________

Telephone: ___________________ (Home)

____________________________ (Mobile)

_____________________________ (Work)

Relationship: _________________________

Date appointed: ______________________

2. Person ResponsibleI have not appointed an EnduringGuardian, but I would like the followingpersons, if available, to be my PersonResponsible (in order of preference).

Name: _______________________________

Telephone: _____________________ (Home)

______________________________ (Mobile)

______________________________ (Work)

Relationship: __________________________

Date appointed:________________________

3. Person ResponsibleName: ____________________________

Telephone: ____________________ (Home)

____________________________ (Mobile)

_____________________________ (Work)

Relationship: ________________________

Date appointed: ______________________

I have given a copy of this ACD to:

GP ________________________________

Solicitor ______________________________

Enduring Power of Attorney

____________________________________

Other__________________________________

___________________________________

On this form you are only telling us who your Enduring Guardian is. To appoint an EnduringGuardian and to lodge notice of that appointment with the Guardianship AdministrationBoard of Tasmania, you will need to complete a specific form.http://www.publicguardian.tas.gov.au/enduring_guardianship


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What to do with your completed Advance Care Directive

After completing this Advance Care Directive the original remains with you and copiescan be given or sent to:

Your Person/s Responsible, or Enduring Guardian, Joint Enduring Guardians, andalternate Enduring Guardian if you have appointed one and

It is also highly recommended that you show it to relevant healthprofessionals such as your general practitioner, community nurse, andmedical specialists, and where appropriate discuss it with them and givethem a copy.

You may wish to share extra copies with others e.g. family members, close friend,next of kin, your minister of religion, or your solicitor.

If you are a resident in an aged care or other residential facility, it is advisable that staff areaware of this ACD and that a copy should be kept in your file.

Note: if you are the Person Responsible and have completed this ACD on behalf of a personwho already lacks capacity, you should keep a copy of the ACD, and give a copy to the persons GP,

and any other people who have responsibility or care of the person, (including residential carefacilities).

You may wish to send a copy of this ACD to the Medical Records Department of the local hospitalfor entry into your medical record.

How to change or revoke an Advance Care Directive

You can change or revoke your ACD, or the people nominated to speak on your behalf, by

writing, signing and dating a new document which clearly states that the previousarrangements have been changed or revoked. The new document should be witnessed bysomeone independent, and it should be clearly dated. The most recently dated documentoverrides any older one.

There are a number of reasons why you might want to change or revoke your Enduringguardianship or ACD. Maybe your relationship with your Enduring Guardian or PersonResponsible has changed or the person you appointed is no longer appropriate for the role.Your medical and other circumstances or wishes may have changed.

If you have registered your Enduring Guardianship documents with the Guardianship

Administration Board, Tasmanian law is specific about how to revoke that document. Youmust complete a Revocation of Enduring Guardianship form. It is also important to informyour Enduring guardian of the changes and provide them (or the new Enduring Guardian)with the new documents.

Whether your ACD is lodged with the Guardianship Administration Board or not, it isimportant to review it from time to time, even if you are not making any changes. Youshould sign and date the form again so that it remains as current as possible.

7

ADVANCECARE

DIRECTIVEFORCAREA

TTHE

END

OFLIFE

(TA

SMANIA)


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[NB. This document has been approved for pilot use, and further evaluation, by aWorking Party of the Tasmanian Palliative Care Clinical Network, and the Clinical EthicsCommittee of the Southern Tasmania Area Health Service. It is based on the instrumentsdeveloped and experience gained as part of the Respecting Patients Choices program at RHH,Austin Health and nationally.

As Advance Directives are common law documents in Tasmania, it is not a statutory document.It can be used by any citizen or institution, but no changes should be made to it.It does NOT replace the statutory Enduring Guardianship form.

For more information, or to make comments about this particular form of Advance Care Directiveand End of Life Decision Making, go to the Palliative Care Clinical Network:www.pallcareclinicalnetworks.dhhs.tas.gov.au, or or [email protected]

8


MORE INFORMATION ABOUT ADVANCE CARE DIRECTIVES,ENDURING GUARDIANSHIP and END OF LIFE DECISION MAKING

If you would like more information about Enduring Guardianship in Tasmania, go to theweb-site of the Guardianship Administration Board:www.guardianship.tas.gov.au/enduring_guardian/publications, where you can download a factsheet and forms for appointing an Enduring Guardian (phone 6233 3085)

Or contact the Office of the Public Guardian at [email protected] phone62337608

You can also access information sheets and forms from Service Tasmania Centres

For legal advice you can phone 1300 366 611


END

OFL

IFE

(TASMANIA)


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Attachment 5

Suggested Process in Establishing

Enduring Guardianship

and

Issues and Responsibilities in acting as an

Enduring Guardian.

Step by Step Guide to writing an Advance Care Directive (ACD) or appointing an EnduringGuardian (EG).

Guide to the Role of Enduring Guardian (or Person Responsible). Some Common Questions and Answers


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Attachment 5-1: Step by Step Guide to writing an Advance Care Directive (ACD) or

appointing an Enduring Guardian (EG).

By yourself, think through your beliefs, values and the things that are most important in yourlife, making notes for yourself as you go along. It is important to think about outcomes and

situations rather than specific medical interventions at this stage. And it is important to think

independently about your own wishes before opening yourself to influence from others.

You may want to think about the things that make day-to-day life enjoyable:

For example -

seeing my family keeping up with my social group interests or activities such as gardening or bushwalking the ability to arrange my own life in my own way, without having to depend unduly on

others.

If 'independence' is important to you, think about what level of necessary support wouldresult in you feeling that you had lost independence.

You may also want to think about deeper things related to the end of your life:

For example -

I believe that my life is properly in God's hands. I, and only I, have the right to choose whether I want to go on living. I would not want to carry on if there is no hope of recovery to independence I have seen the load on other families through the last stages of a long dying process and I

don't want that to happen to my family.

I don't think it is ethical to take up a lot of scarce skilled resources simply to keep me alivewhen there is no hope of recovery.

Think about what kinds of outcomes you would or wouldn't want from future medical care:

For example -

I wouldn't want to go to intensive care and be hooked up to machines unless there was agood chance of making a good recovery.

If I can't hold a normal conversation with people any more, I would see little point inliving.

I wouldn't mind being physically immobile, but I would hate to not be able tocommunicate with my friends.

I am frightened of dying in pain and without dignity, so I would want to be keptcomfortable.


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Writing these things down in brief points is useful at this stage. Talk to your family, and other people important to you about these things, and let them know

what you would want if the time came when you were unable to express your wishes.

Think about who you would want to speak on your behalf if you couldn't understand orcommunicate your wishes for yourself. Talk to that person about whether they are prepared tospeak for you. Before committing yourself to ask that person to act for you, you need to be

very sure that they understand what you wish and its implications and that they are prepared to

support you fully. If they do not agree and are not prepared to support you, find someone else

to act for you. You can also specify in your EG or ACD any person you specifically want to

have no say in your treatment or care. It is essential to ensure that the person you plan to

appoint understands the role and duties of an Enduring Guardian or other Person Responsible.

There are notes for guidance of an Enduring Guardian or Person Responsible in the next

section of this Attachment.

If there is no-one who is prepared to become your Enduring Guardian (or who you areprepared to ask), a very carefully worded ACD provides almost as much certainty that your

wishes will be followed.

Write an ACD or an EG (there are a number of alternative forms of wording that may help inthis set out in Attachment 6). When writing the document, you should focus as much as

possible on outcomes rather than medical processes. Example C of Attachment 6 contains

examples of this sort of wording.

Ensure that the statement is properly witnessed by a person who is not a relative or abeneficiary and, in the case of the EG, lodge it with the Guardianship and Administration

Board.

Tell your doctor, your family and other people who you think should know that you have madean ACD or EG. Give them copies. Tell themwhere you keep your copy at home.


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Attachment 5-2: Guide to the Role of Enduring Guardian (or Person Responsible).

Terminology and abbreviations

AnEnduring Guardian is one appointed through an Enduring Guardianship (EG) which hasbeen registered with the Guardianship and Administration Board.

AnAdvance Care Directive (ACD) is a written set of instructions or wishes about future healthcare and treatment. It may be simple or detailed and may or may not be on a form.

Person Concerned (PC) is the most common term used in health care institutions for the personwho has prepared the Enduring Guardianship form or Advance Care Directive (ACD) or who

needs someone to speak on their behalf.

Person Responsible (PR) is the most common term for the Enduring Guardian or other personacting for the Person Concerned when he or she is incapacitated.

Who has the legal right to speak on behalf of the Person Concerned?

If the patient is an adult, the Person Responsible in priority order is either:

a guardian (including an Enduring Guardian) who has the power to consent to health care,which includes the power to refuse or withdraw consent to treatment

a spouse - including a de-facto spouse an unpaid carer who is now providing domestic services or support to the patient, or who

provided these services and support before the patient entered a residential facility, or

a relative or friend who has both a close personal relationship and a personal interest in thepatient's welfare,

unless someone is specified as the Person Responsible or specifically excluded by the Person

Concerned in the EG or ACD form.

Role and powers of the Enduring Guardian or other Person Responsible

In most cases the duties of the Enduring Guardian or Person Responsible are fairly straightforward,

but they can be substantial

The active part of their job begins when the Person Concerned loses decision-making capacity and is

no longer a

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