Advance Care Directive vs Advance Care Plan in Australia
Advance Care Directives and Advance Care Plans sound like the same thing. They're not. One can record binding treatment directions under the applicable state rules. The other is a conversation record that guides healthcare providers. Confusing the two leaves families believing their parent's treatment wishes are legally protected when they may only be advisory.
Advance Care Directive: Legally Binding
An Advance Care Directive (ACD) is a state-specific document whose legal effect depends on the jurisdiction and how it is completed. When properly executed under the applicable rules, it can give binding directions about the treatments it covers.
The specific name and scope vary by state:
- South Australia — the Advance Care Directive under the Advance Care Directives Act 2013 covers all personal, lifestyle, healthcare, and accommodation decisions. SA's ACD also allows the principal to appoint Substitute Decision-Makers, effectively replacing the old Enduring Power of Guardianship.
- Queensland — the Advance Health Directive (Form 4) under the Powers of Attorney Act 1998 covers specific healthcare decisions. It can include binding refusals of treatment.
- Victoria — the Advance Care Directive under the Medical Treatment Planning and Decisions Act 2016 allows a person to document binding instructions about specific medical treatments.
- Western Australia — the Advance Health Directive covers binding treatment refusals.
- Northern Territory — the Advance Consent Decision section of the Advance Personal Plan records binding treatment directions.
What makes these legally binding is compliance with the relevant jurisdiction's execution and witnessing rules. Those requirements vary by state and territory, so the official local form or guidance controls whether the document is effective.
Advance Care Plan: Advisory Only
An Advance Care Plan (ACP) is a less formal document, typically completed during a conversation between the person, their family, and a healthcare provider. Aged-care facilities, hospitals, and GPs encourage ACPs as part of routine care planning.
An ACP records the person's values, preferences, and goals for future care. It might say the person wants to remain at home as long as possible, prefers comfort care over aggressive treatment, or has specific religious requirements around end-of-life care.
Healthcare providers are expected to consider an ACP when making treatment decisions. But "consider" is not the same as "follow." If a treating doctor believes the ACP preferences conflict with the patient's best interests, or if the clinical situation has changed significantly since the plan was written, the doctor can exercise their own clinical judgment.
The critical difference: a properly completed, applicable ACD can say "do not resuscitate" and the hospital must follow that binding direction. An ACP can say "I prefer not to be resuscitated" and the hospital will take it into account — but it isn't obligated to follow it if the treating team believes resuscitation is clinically appropriate.
Why the Confusion Is Dangerous
The practical danger is that families complete an Advance Care Plan with their parent's GP or aged-care facility and believe the hard work is done. They don't realise the ACP isn't legally binding, so they don't go on to execute a formal Advance Care Directive with the proper witnessing.
This becomes a crisis when:
- The parent is admitted to hospital and the family presents the ACP, expecting the hospital to follow it. The hospital treats it as guidance, not an instruction, and proceeds with treatment the parent would have refused.
- Family members disagree about treatment. An ACP can be overridden by a statutory decision-maker (the person highest in the "person responsible" hierarchy or the appointed enduring guardian). A properly completed ACD generally takes priority for the specific treatments it addresses, subject to the applicable state or territory rules.
- The parent enters residential aged care and the facility asks the family to "update the care plan." The family updates the ACP, believing it has the same force as the ACD they never created.
Free Download
Get the Enduring Power of Attorney and Guardianship in Australia — Quick-Start Checklist
Everything in this article as a printable checklist — plus action plans and reference guides you can start using today.
When You Need Both
For most families, the right approach is:
An Advance Care Directive for any specific medical treatment the parent wants to refuse or consent to in advance — particularly around end-of-life care, mechanical ventilation, artificial nutrition, and resuscitation. This is the document used to record binding directions under the applicable state or territory rules.
An Advance Care Plan for the broader conversation about values, preferences, and goals of care. This is the document that helps healthcare providers understand what matters to the parent when they're making decisions about treatments the ACD doesn't specifically cover.
An enduring guardianship instrument (Appointment of Enduring Guardian in NSW, Medical Treatment Decision Maker in VIC, or equivalent) to appoint someone to make the medical decisions the ACD doesn't cover and to handle the situations the parent couldn't anticipate.
None of these replaces the others. The ACD handles specific, foreseeable treatment decisions. The ACP provides context and values. The enduring guardian makes the judgment calls for everything else.
Getting the Documents Right
The Enduring Power of Attorney and Guardianship toolkit covers the Advance Care Directive requirements for each state alongside the EPOA and guardianship instruments — so families can set up all their decision-making documents in one coordinated process rather than discovering the gaps after a hospital admission.
Get Your Free Enduring Power of Attorney and Guardianship in Australia — Quick-Start Checklist
Download the Enduring Power of Attorney and Guardianship in Australia — Quick-Start Checklist — a printable guide with checklists, scripts, and action plans you can start using today.