Advance Care Directives - Document Redesign Project

There has been very little done in the review of the advanced care directives apart for some changes to appearance of documents. I believed the review of the advanced directives meant just that. Nothing has changed to make it simpler for consumers and more easier health care professional in time pressing situations. I believe few of Professor Lacey's recommendations have been adopted and been included. The "Act" it self still has many areas that need updating and changes need to be made. There is conflicting information in the material presented. The Advanced Care Directive's form, The Guide, The Act, and the information supplied on FAQs.
There needs to be a lot more work done on this review and the documents presented. Even the "review principles" written in this website indicated no more that a "Face Lift" to how the document are being presented.

make this compulsory to do one advanced care directive to everyone who turns adult

When will dying individuals be afforded a choice of either palliative care or VAD.
Currently, the latter cannot be suggested by medical personnel as it may be seen as coercion. This is absolute nonsense.
All diseases have treatment choices, when will dying be included?

General Observation - as an active JP in two busy locations I do about 50 ACDs a year where donors actually talk about their reasons for doing so. Not being in the medical/surgical/ hospital environment I have a blinkered view of the extent of the usefulness of ACDs in real life. My figures are approximate - more than half of donors do so of their own volition, or after hints from friends or family, without there being an existing or impending health problem, or doing an ACD in conjunction with POA and/or will. A small minority have next to no idea what the ACD fully represents, or they do, but can't articulate it because they are nervous in the circumstances of the JP interview. Some just want the ACD in place because they've heard about it and most sections of the document are blank and need the Z treatment. Your proposal that everyone within cooee needs a certified copy is overkill and a time waster. Depending on the circumstances, e.g. spouse or No.1 decision maker would be adequate. Copies of the 'original' certified copy could be reproduced or scanned later if required, or let the the parties copy the certified copy. It has not been established that the relevant critical nursing or hospital staff acknowledge the authority, if any, of a Certified Copy. (In 2021 a professional medical body (not the AMA) publicised that they would not pay any attention to a ACD).
In your proposal "What to do with your completed ACD" there if no mention of what to do with the ORIGINAL.

I’d like to see a Register of completed ACDs, digital and online, which is accessible by hospitals in SA. Currently a hard copy has to be somehow made available to clinical staff for the ACD to guide clinical decisions; made available either by the patient or the alternative decision makers being present with the patient. It would be better if in emergency presentations that the ACD can be quickly accessed so that unwanted types of care are not initiated only to have to go through a withdrawl process later. It can be opt-in to avoid criticisms of coercion.

The certified copy section is still confusing. While training will be provided it would be clearer to label the section on Page 1 CERTIFIED COPY CERTIFICATE with a box for the certification statement, and a second box for the witness signature and authority (eg, JP stamp). It is my practice to also sign and date each page of the certified copy but can find no guidance on this. There is also no example of the certificate in the guide, so the guidance on certifying copies in the JP Services Handbook on certifying copies could be followed?
Additional guidance on how electronic signatures are applied would be useful.
In part 9 of the form, the words "appointed Substitute Decision Maker" appear to be erroneous. The words should be "Authorised Witness"

Hello, could specialist nurses working in non Palliative or Geriatric environments undertake a formal accreditation from Pall Care or Geriatrics be allowed to transfer information from pre-existing documentation to the current EMR including updating in accordance with current legislation the Resuscitation Order for the visit.
Currently, the EMR allows permissions for this, but legislation is yet to reflect same.
Patients often disclose what their wishes are, without prompts, but we have no governance to enter it officially into the medical record, except via a standard progress note, which only records it as conversation not legally binding statement.
Bedside nurses could then alert available accreditated nursing staff (or MO's) and a more formal, but less intimidating conversation could take place.
These accreditated nurses could also ask questions regarding same much earlier in the visit to hospital (via ED mostly) for timely recording of wishes.

For those thinking, but you can just scan a document, EMR scanning happens on d/c and NFR orders etc, are required EVERY VISIT, even if the ACD has not changed.

The cut out card at the back should have the binding refusals on it.

The binding refusals should have prompts that replicate a 7 step pathway. In fact this document should incorporate the 7 step pathway as an appendix that should be completed AT THE SAME TIME.

The ACD should be noted as a lego-medical document; ie notarised out by a NON health care professional and the 7 step pathway as a medico-legal document; notarised by specific Health Care Professionals.

One is filled out

Page 39 of the Guide. indicates for Training go to http://sa.jpto.org.au/ this site does not exist. Refer page 44 of the Guide for the correct website.
There has been numerous errors with the use of the current "Certification Statement". Both JP's and others have used this box to place their stamp/qualification when completing the ORIGINAL document. The wording needs to be changed to become more specific. Ie: "COPY certification statement".
Parts 2b: and 2c: could be combined for the appointee to indicate in what order of preference should an SDM's be consulted/contacted.
Page numbers to include Page 1 of 10 etc. This prevents substituting pages after they have been witnessed. When certifying copies, JP's are required to identify the number of pages (1of 10, 2 of 10; etc) initial and date each page.
Should a decision be made to ADD extra pages (eg. SDM's) this will cause confusion with the page numbering identified at the bottom of each page..
Guide page 38; Second to last paragraph should read "Fill in the Witness Statement in Part x of the Advanced Care Directive. Part x should read Part 9: (the number of the final document).
Guide page 38; The last paragraph, middle line reads" Please see page x (in red) of the Guide, etc". this need the actual page number.

No 1 -The first page section for JP's needs to read ": For the use of JP's for certification of copies only" Far to many JP's don't know there job and obviously attend training or read their manual and record their JP stamp there on the original copy.
No2 - Most Donors do not use the various condition sections available to them and if they do its rarely 1 or 2 so they could be reduced in size along with print size thus reducing the number of pages and cost.
No3 - The wording on the witness statement where it reads "and I certify I gave (Donors name) a copy of the Advanced Care Directive Information Statement" needs to be changed to read "I certify (Donors name) was given a copy of the Advance Directive Information Sheet" because I have never been needed to because the Donor has either down loaded one with the copy of the form, purchased a form with it attached, or purchased it in book form which includes it. The current wording is causing issues where the JP has ether got to pretend to give the Donor one or lie, or maybe manually change the words.

What a fabulous change. Much easier now. Love the numbered pages

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Having supported two elderly relatives during their final years, I am keen to see a simplified form that asks questions immediately relevant to their situation. This goes some way towards that but it still presents as a dense legal document (layout, structure, length) and uses terms that would need to be translated into everyday language for many people (eg health practitioner = doctor). I also think that forcing people to confront every topic/issue in one form is a deterrent to getting them to fill in any of it. Is there a reason why the sections of the form cannot be dealt with separately? I think that getting a person to tackle one issue at a time would make it easier to work through the issues. In my experience of trying to support people to engage with bureaucracy in the context of aged care, the shorter and simpler the better.

There is no indication when a person completes an ACD that is is not a replacement for an old one. Suggest a line and boxes to indicate:
"Is this Advanced Care Directive a replacement for a previous one....YES NO"
in this and in previous ACD there was/is no indication for when an ACD is replaced. I believe this would tie up some 'loose ends'.