Advance Directive NZ: How It Works and How It Differs From an EPA

An Enduring Power of Attorney gives someone else the authority to make decisions for your parent. An advance directive lets your parent make specific medical decisions now that take effect later — even if they lose capacity and even if the EPA attorney would decide differently.

These two documents serve different purposes, and families navigating elder care in New Zealand need to understand both.

What an Advance Directive Is

An advance directive (AD) is a legally binding statement where a competent person consents to or refuses specific future medical treatments in the event they lose the ability to communicate. Common examples include refusing cardiopulmonary resuscitation (CPR), declining artificial ventilation, or refusing tube feeding if the person has a terminal illness with no prospect of recovery.

In New Zealand, an advance directive is often embedded within a broader Advance Care Plan (ACP). The ACP itself is non-binding — it documents the person's values, spiritual beliefs, end-of-life preferences, and funeral wishes. But the advance directive section (typically Section 6 of the standard ACP form) carries legal force.

The critical distinction: only the donor can create an advance directive. An EPA attorney has no legal authority to write, sign, or modify one on behalf of an incapacitated parent. If your parent wants specific medical wishes recorded and legally enforceable, they must do it while they still have capacity.

How It Overrides an EPA

Under the PPPR Act, an EPA attorney for Personal Care and Welfare is explicitly prohibited from refusing consent to standard, life-saving medical treatments. This is a hard statutory limit — no matter what the attorney believes the parent would want, they cannot legally refuse life-saving care.

But a valid advance directive can. If a parent has executed an AD that explicitly refuses a specific treatment, that directive is legally binding on clinicians and overrides clinical best-interest assessments. The directive speaks with the donor's own voice, from a time when they had full capacity to make the decision.

This creates an important gap: without an advance directive, a parent's wishes about end-of-life care are legally unenforceable. The EPA attorney can advocate for what they believe the parent would want, but they cannot refuse life-saving treatment.

What Makes an Advance Directive Valid

New Zealand clinicians evaluating whether to follow an advance directive must work through five validation questions:

1. Was the person competent when they created it?
2. Was it voluntary — made without external pressure?
3. Was the person informed about the specific treatment and consequences of refusing it?
4. Did they intend it to apply to the current clinical circumstances, which may differ from what they anticipated?
5. Is it current — or have clinical options changed significantly since it was written?

If any of these questions raises doubt, the clinician may override the directive in favour of treatment. This is why specificity matters: a directive that says "I refuse all medical treatment" is far more vulnerable to challenge than one that says "I refuse CPR and mechanical ventilation in the event of a terminal diagnosis with no prospect of meaningful recovery."

Advance Care Plan vs. Advance Directive

How to Create an Advance Directive

There's no single prescribed form for an advance directive in New Zealand — unlike EPA forms, which must use the official Ministry of Justice templates. However, the most widely used framework is the national Advance Care Plan form available from myacp.org.nz, which includes a dedicated section for legally binding treatment decisions.

The process should involve a conversation with the parent's GP or specialist, who can explain the practical implications of refusing specific treatments. A directive that says "no CPR" means something very different for a parent recovering from a treatable infection than for a parent with terminal cancer, and the clinician can help frame the directive so it covers the intended scenarios without unintended consequences.

The completed directive should be shared with the parent's GP, the EPA attorney, the rest home or care facility (if applicable), and any family members involved in care coordination. A copy should be attached to the parent's health record.

Why Both Documents Matter

An EPA without an advance directive leaves end-of-life medical wishes legally unenforceable. An advance directive without an EPA leaves day-to-day care decisions, financial management, and residential placement with no authorised decision-maker.

Families should ideally complete both while the parent has full capacity. The advance directive records what the parent wants in specific medical scenarios. The EPA appoints who makes all the other decisions — from choosing a rest home to accessing bank accounts to signing admission agreements.

Our Enduring Power of Attorney in New Zealand guide covers both documents in detail, including how they interact and a checklist for ensuring nothing falls through the gap between the two.

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