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Study finds end of life care being left to chance


More than two thirds of older Australians have not left any legally recognised instructions about their end of life care for when they are unable to make their own medical decisions, and half have left no directions at all, according to new research.

Dr Karen Detering

The study by Advance Care Planning Australia (ACPA), which reviewed records of 2,285 people from 51 hospitals, aged care facilities and GP clinics across six states and territories, is the first to provide comprehensive information about the prevalence of Advance Care Directives (ACDs) in Australia.

Data was collected between September 2017 and January 2018. It found that only 30 per cent of people had an ACD, or a structured and signed legal document. Twenty per cent had other forms of informal documentation.

The odds of having an ACD were lower in hospitals and general practices than in residential care facilities.

ACPA Medical Director Dr Karen Detering says it is concerning that most older Australians are leaving their future health care to chance.

“Without a plan, older people may be left vulnerable and potentially without a voice. And far too often loved ones are left to blindly make decisions under the worst circumstances.

“As a medical practitioner I’ve witnessed these scenarios and I can tell you it’s a heart-breaking way to say goodbye to your loved ones.”

Lack of clarity

The study looked at the prevalence of both ACDs, a document recognised by law, and ACPs, or informal documented advance planning discussions.

It found a wide range of documentation across the cohort and a lack of clarity between ACDs, which are recognised by an act of parliament, and those that were recognised under common law.

The study called for the standardisation of ACDS across state and territory jurisdictions to make it easier for older people to complete one and ensure their wishes are respected when they approach the end of life.

“Lack of clarity regarding the legal status of non-statutory ACDs may reduce clinician confidence and therefore the likelihood that preferences are actually followed in practice,” the study said.

Statutory ACS could also safeguard against duress, fraud or undue influence, it noted.

Navigating the advance care planning landscape

Dr Detering said the research, published in BMJ Open, offered a starting poing to better understand the national advance care planning landscape.

“This valuable baseline data will be used to inform policy in advance care planning, which is becoming an increasing healthcare priority,” she said.

ACPA is running an awareness initiative during Advance Care Planning Week from April 1 – 5. You can find out more here.

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