FAQs

An Advance Care Directive (ACD) is a legal document that allows South Australians over 18 to:

• record their wishes, preferences and instructions for their future healthcare, residential and accommodation and personal affairs (these are the words in the ACD).  
• appoint one or more substitute decision-makers (SDMs) to help you if you are unable to make a particular decision.

An ACD makes it easy for others to know what your wishes and preferences are for your healthcare, where you want to live and personal decisions if you are unable to make these decisions yourself. The more details you include about your wishes and instructions for the future, the better equipped your SDM is to make the decision you would have wanted. You can include end of life.

An ACD does not cover decisions about finances, property or legal affairs.

The ACD Act 2013 governs ACDs.

An ACD replaces the following documents: Enduring Power of Guardianship, Medical Power of Attorney and Anticipatory Direction documents.

An ACD includes old Enduring Power of Guardianship, Medical Power of Attorney and Anticipatory Direction documents. This means that if you made one of these documents before the Advance Care Directive Act 2013 came into effect they are still valid and are considered an ACD under the ACD Act.

To find out more, or to get an Advance Care Directive form, you can:

• Download from or complete an Advance Care Directive on the website – www.advancecaredirectives.sa.gov.au
• Buy a hard copy from Service SA – http://service.sa.gov.au/ or call 13 23 24
• Call the Legal Services Commission on 1300 366 424
• Visit the SA Health website.

An ACD replaces the following documents: Enduring Power of Guardianship, Medical Power of Attorney and Anticipatory Direction documents.

An ACD includes old Enduring Power of Guardianship, Medical Power of Attorney and Anticipatory Direction documents. This means that if you made one of these documents before the Advance Care Directive Act 2013 came into effect they are still valid and are considered an ACD under the ACD Act.

If you had an old Enduring Power of Guardianship, Medical Power of Attorney or Anticipatory Direction document and you complete an ACD, these other documents are revoked.

A Power of Attorney (POA) covers legal and financial matter. A POA does not give someone the authority to make decisions about your healthcare, accommodation and personal decisions.

No, if a person has specified particular health care they would accept, this is an indication of consent, if it is considered clinically appropriate to offer the health care. However there is no obligation on the health practitioner to provide the health care if it is not considered to be of benefit to the patient.

A substitute decision-maker is someone you choose to make medical treatment decisions on your behalf if you are not able to do so.

They should be somebody:

• you know and trust
• who is over 18 
• who will listen carefully to your values and preferences for future care
• who will be comfortable making decisions in difficult situations.

When choosing your substitute decision-maker, you should ask yourself the question: ‘Am I confident this person will make decisions based on what I would want?’

Some people to consider are your:

• partner or spouse
• friend
• sibling
• adult child
• parent

Whoever you choose, they must be able to stand in your shoes and understand your values and wishes and follow your Advance Care Directive as instructed by you. 

Substitute decision-makers are not guardians. Here are some main points of difference:

Substitute decision-makers 

• Are appointed by you, in anticipation of you losing decision-making capacity in the future.
• Help if you are unable to make a particular decision for yourself. 
• Ask you about your wishes and needs. 
• Strictly follow any medical refusals (these are legally binding). 
• Consider your past and present wishes, and your proper care and protection. 
• Try to make decisions as you would have made them (“stand in your shoes”).

Guardians 

• Are not appointed by you 
• Are appointed after a person has lost decision-making capacity. 
• Are appointed by a relevant Court or Tribunal (Guardianship Order).
• Guardianship Orders are time limited. 
• May have reporting obligations.
• Have authority to make decisions on behalf of the person even if the person regains capacity, and can continue to do so until the Order appointing them is varied or set aside.

The main difference is that you choose who you want to make decisions when you appoint a substitute decision-maker and you must have capacity to do so. Whereas a guardian is appointed for you, which happens when you no longer have decision making capacity. A substitute decision-maker appointed under an ACD has the same authority as a guardian appointed by the South Australia Civil and Administrative Tribunal (SACAT). Both a substitute decision-maker and a guardian can apply to SACAT for special powers. 

If you are over 18 years old, in order to make legal documents and consent to medical treatment, you need to have decision-making capacity.

Impaired decision-making capacity means that you are unable to manage parts of the decision-making process.

If you have impaired decision-making capacity, you may not be able to:

• Understand some or all of the information that is relevant to a decision,
• Understand the consequences of a decision,
• Remember the relevant information, even for a short time,
• Use this information to make your decision, and,
• Communicate your decision to others in some way.

You may be able to make one decision, and not another – your capacity should be assessed in relation to each particular decision.

You may still have the capacity to make a particular decision, even if:

• You are not able to understand trivial or technical information.
• You can only remember information for a short period of time.
• You make a decision that results in a negative outcome.
• Your capacity fluctuates between full decision-making capacity and impaired decision-making capacity.

If you have impaired decision-making capacity, you may need help from:

• A family member or friend, who makes decisions informally
• A Person Responsible, who makes health care decisions
• A substitute decision-maker, who is appointed under an Advance Care Directive
• A guardian, who is appointed by the South Australian Civil and Administrative Tribunal (SACAT).

You are welcome to indicate your preferences/wishes in relation to Voluntary Assisted Dying in your Advance Care Directive, however it is important to note these preferences and wishes will render no legal effect in accordance with the Advance Care Directives Act 2013 and will not legally constitute a request for Voluntary Assisted Dying.  In order to access Voluntary Assisted Dying, you will need to meet the requirements in accordance with the Voluntary Assisted Dying Act 2020, noting that the Act is yet to commence in South Australia.

Yes! We are in the process of amending our policy to allow digital signatures for substitute decision-makers (SDMs) and interpreters on our online form. We understand that your SDM/s may be located interstate or rurally and that obtaining their signatures has been tricky in the past so we have made this change to help you complete your Advance Care Directive (ACD) in a timely manner. 

Signatures of SDMs and interpreters, do not determine the legal validity of an ACD and are not necessarily instrumental in ensuring its effectiveness, especially if no SDMs are appointed or if an interpreter is not used.

However, it is a legal obligation for your witness to sign your documents in person and therefore they're unable to sign your ACD digitally. You must also sign the declaration in person in front of your witness. 

You can raise this with the doctor in charge of the patient’s care or senior management. 

You can make an application to the OPA’s Dispute Resolution Service (DRS). The OPA DRS has authority under the ACD Act to assist people to work through disagreements about health, accommodation, and lifestyle decisions. The OPA DRS does this by giving information to people about their rights and obligations under the ACD, helping SDMs to uphold the wishes stated in ACDs, assisting people to communicate about decision-making and disagreements and facilitating mediations/family meetings.

Other options include reporting your concerns to the relevant Health Practitioners’ Tribunal or the Health and Community Services Complaints Commissioner.