There's a few ways that The Office of The Public Advocate helps with Advance Care Directives.

One is that we have lots of information on our website that people can access about Advance Care Directives and substitute decision making.

The second is that we have an information service where people can call.

We have an Information Officer who can answer lots of or any kind of questions.

We have a dispute resolution  service and what we do is we help people to  resolve issues that arise around decisions and decision makers.

We can actually come in and help to resolve those issues.

Can you tell me about your role with Advance Care Directives?

You're a Justice of the Peace what do you have to do with them?

So I've been a Justice of the Peace for 11 years.

As Justices of the Peace for South Australia we are well trained, to learn how to witness them.

You make sure that people understand what they've written and when it will be used ?

Yes yes - we ask the questions on why and maybe what's in the ACD and if there's someone sitting beside them trying to answer for them, we just ask them to leave ..quietly because it's all about the person, making sure it's their wishes. Their wishes, yeah.

We're available in most community centres, libraries and we're all volunteers.

Fantastic thank you.

What's the difference between an  ACD and a Medical Power of Attorney?

Well.

I should know this! I'm not going to answer this correctly. Pass, Pass.

There are a few differences.

The Medical Power of Attorney was a document that was made before the Advance Care Directives came in into effect in 2014.

You can't make a Medical  Power of Attorney anymore.

Now the Advance Care Directives have replaced those documents.

Another difference is that when we made a Medical Power of Attorney they only appointed somebody to make health decisions.

Whereas the Advance Care Directive appoints somebody to make health, accommodation and lifestyle decisions.

When the Medical Power of Attorney  was signed and witnessed it came into effect essentially straight away.

Whereas the Advance Care Directive is really only used as it's needed,when somebody loses the capacity to make a particular decision for themselves.

But if you have a Medical Power of Attorney that was made before 2014 it's still valid if you haven't made an ACD.

But we recommend that people make an Advance Care Directive if they want to update those documents.

I'd be getting some legal advice because I don't really know for sure either.

Which is a good point  - council don't give legal or medical advice.

Should the same person be on your ACD and be your Power of Attorney?

What if they would prefer your money than keeping you alive? Ooh.

I shouldn't laugh, it's a serious point. I think older people are concerned that somebody might abuse these documents by putting their names down.

I think statistics say if you have these documents, you're more protected, and it's up to you to then choose that trusted person and that trusted person might be one either or both.

So I'll again use the phrase.. it depends.

First, what decisions am I asking them to make and who is best placed to make those decisions?

It can be the same person but it's just whether or not you're satisfied that it's appropriate for that person to make those decisions;whether they are the best person to make those decisions.

The other part of that is if they are different people, it is a benefit that at least they know who the other person is.

There's a difference between the Substitute Decision Maker and the Power of Attorney.

So, the Power of Attorney would deal with your finances, and you might opt to have a different person dealing with your health and your care.

Pick trustworthy people. You would hope that everyone would pick trustworthy people.

You make the decision of who's doing it so make sure you pick people that you actually trust to do both jobs.

Okay this is a very technical question.

Can I make two different ACDs to cover two different scenarios?

No, No, No.

The short answer to that question is no.

The way it works is when you complete an Advance Care Directive it's going to cancel any previous Advance Care Directive document that you've created.

But what you can do within your ACD is to write if 'X' happens I would like 'Y' to happen and if 'Z' happens I would like 'A' to happen, so you can cover different scenarios within one document, but you can only have one.

So, if there are different scenarios that you have in mind you can spell those out in your Advance Care Directive.

One form for lots of different situations to cover.

I made one years ago, is it still valid?

Yes, it is still valid. Yes.

Yes, but that's the short answer. It also might be some years out of date.

Yes it is, I believe. You should review them regularly to make sure that it reflects what your decision making would be now.

If that's still on your fridge, it is still valid until you're actually thinking about updating it.

And when you do update it, if you do update it, it supersedes all the previous ones.

Yes, so as soon as you make a new Advance Care Directive, the old one is no longer valid.

If your health has changed it might not be appropriate or relevant but that's a little bit different.

I always feel that sometimes when I give that advice that people might think I'm trying to drum up more business for lawyers but I think it is that idea of, you know, taking that document out every couple of years, looking through it and just making sure it's still doing what you want it to do.

It's a lot - do I have to fill it all?

Ooh, no you don't. You fill in as much as you're comfortable with.

You don't, it's completely optional, how much of the form you fill in.

It is a lot - you can fill in as much as you like or as little as you like.

It is a lot, you know that it seems easy you get through the first bit 'who am I?' -that's easy - and then you hit with that question ‘What is important to me?'

The more information you put in there the better it will be and the more opportunity that decision makers have to uphold your wishes.

You really need to think about it - probably for a number of hours, before you actually start committing things to writing.

Or days or weeks. Yes.

The first bit, part three, is the soft bit, it’s not legally binding but it’s really useful to fill it in. It gives that big picture of you as a person.

I suppose sometimes those things feel a bit fluffy and unimportant but actually when we're talking about the end of life it's very important.

The guiding principle for this document is - what are your values, what are your wishes, what is important to you? And the form is an opportunity for you to put that in writing.

I guess ultimately we just want to make sure that if someone picks up your Advance Care Directive they can understand what your wishes are.

How can it work when your family have different beliefs?

That's a tricky one - that's a real tricky one.

Well it's not about their beliefs, it's about your beliefs.

It's your decision you make the decisions, this is all about you.

I guess it's about talking to your Substitute Decision Maker, that they're going to stand in your shoes.

This is why it's really important that the Substitute Decision Maker understands that it's making decisions in your frame of mind, like what you want and for goodness sake, have the conversations.

Part of the question in some way speaks to why it is important to consider creating an Advance Care Directive because if you don't have one then what's likely to happen is they'll speak to a family member they won't have the benefit of a document which records what your values are, what your wishes are, what's important to you.

Whoever you choose should be following what you've written down.

It's about your beliefs, not their beliefs, and if they're unable to stand in your shoes and do that then they might not be the right person.

These are your beliefs and these are your feelings but these are mine and I would like you to do this, please do this.

And it might be that your family knows what your wishes are and they'll respect those but obviously there is that risk if their values or beliefs are quite different to yours it creates possible conflict.

The important thing is that the person or people that you appoint as your Substitute Decision Maker are able to uphold your wishes and willing to uphold your wishes and when you have those conversations between you about what you've written in your Advance Care Directive then they say yes, we're okay with that even though it might not be their personal beliefs.

If they're willing to uphold those then that it can still be successful.

Where's the best place to keep it?

Ah where it can be easily found is the short answer.

So you need to keep it where people can see it.

You need to give it to your GP,  you need to give it to your family,  your Substitute Decision Maker needs a copy.

I think you can have it uploaded into My Health Record too, the GP might have to do that though. It's not always easy to upload it yourself.

Not just with your will because it'll be a bit too late by the time possibly that people find it for you.

The best place to keep it might be on the fridge. If you do get an ambulance come to your house they'll look on the fridge and they'll find it.

I've got one of these Medic Alert things and they provide us with a little tag that then you put it on the fridge in the kitchen.

It says there's a Medic Alert bracelet around the place. One of the things I found out is the Medic Alert bracelets now come with a QR code and the ambos can access all of that and an ACD can be part of that QR code.

You definitely need to make copies and hand them out to the people that you've appointed as your Substitute Decision Makers and have conversations with people about what you've written in there.

If you wanted to upload a copy as a digital copy of your Advance Care Directive you  can do that to your e-health record.

The more people who are aware that you  have this document the more people who have that certified copy that will be recognised, the greater the chance that it's going to be brought to the relevant people's attention when needed.

Is it my turn? we'll just go with it. How many Substitute Decision Makers are a good idea?

Mine are so old they may die before me!

Think I'm going to slip into being a very typical lawyer here but I suppose the answer to that question is.. it depends.

Got to be the right people. I don’t think there is a fixed number.

The new form’s got four in the booklet and you can add more on, but I think the more you’ve got, the more confusing it gets for everyone.

It's a tricky one. I would have more than one, I think.

You don't have to have a Substitute Decision Maker at all do you? You can leave that completely blank.

Even if it were the case that your Substitute Decision Makers weren't available, that doesn't mean that there's no longer a purpose to the document.

The document will still exist and can still be used to guide decisions in the future. I think I'd add that I would think at least two, but at the same time if you're going to have  more than one person they need to be people who get on with each other and both understand what you want.

It doesn't have to be a family member, (it) could be your best friends.

As long as there's somebody that you trust to uphold your wishes.

What is there is no one I would ask to be a Substitute Decision Maker for me?

There's a lot of people in that situation so I think, don't feel alone or different and don't let it put you off completing the form.

Any information you put down will still be used.

Well, you don't have to have a Substitute Decision Maker to have an ACD, it's optional.

So still do one but don't put a Substitute Decision Maker in I suppose. Yep.

How much money does it cost?

It’s free!

Well, the form costs nothing and if you get it witnessed by a JP at your local Council that costs nothing.

If you get it witnessed by a lawyer you need to ask the lawyer what they charge.

I guess ultimately you don't have to pay to have it completed.

It can be free, it is free for the kit and you can get it at most libraries and

you can download it online and fill it in online as well. If you're able to do that it's probably the easiest way.

It doesn't cost anything to make an ACD, you can use the do-it-yourself kit and that is completely free of charge and you can also get your ACD signed and witnessed for free by a JP like yourself.

The only thing that would cost money really is if you decided to go to a lawyer to get some help, which is not required but certainly you can do that if you wanted to.

People can access support in order to complete it. Yeah they can.

If they need it, the kit that is available is really really helpful. It can look daunting because it's a big thick document but it's useful that it provides those prompts or suggestions for each section, explanations of these are things that you might want to take into consideration.

People can reach out to the Legal Services Commission; they can book free appointments.

We wouldn't be able to complete a document for somebody but we can again go through what the relevant considerations, might be (to) provide them with that advice.

As you've mentioned people can reach out to the local councils, seek assistance through there or some people might be going to a lawyer, getting a will done and enduring power of attorney and they might seek to get an Advance Care Directive created as part of that.

So I think at the outset they can be anything from free to whatever a solicitor is going to charge to help create it.

How do I know if I have an Advance Care Directive? Well, I would have written one, so I would know that I've had one.

You filled one in!

Well, if you filled one out years ago you could have a little note on the fridge.

If you have taken those extra steps of getting copies made, providing them to other people, storing details on your fridge, there's going to be that clear reminder that one exists.

Your friends and family should know. Friends and family know, yes, hopefully you've had a conversation with some people and you would have filled in the form and you would have had it signed and witnessed.  So hopefully you remember making the document.

You have to complete the Advance Care Directive. Somebody can't create one for you. Absolutely not.

You have to be fully aware and in full control of your faculties and all that kind of thing in order to prepare one. That's right.

Mostly you would know if you've filled one in but if it was part of a lot of things that you were doing I guess possibly you might have not realised you were doing it.

If you were doing it with a lawyer, maybe?

We do have a lot of legal forms that we've got to fill out so sometimes it can be a bit confusing on 'what have I filled out?'

Ultimately, you're the only person and that could fill it out. Good answer.