The living will, Australia

My uncle was on a ventilator in Royal North Shore for nine days before the family agreed about what he would have wanted. He was sixty-eight, lifelong bushwalker, the kind of man who measured his year by how many nights he'd slept under canvas. He had told my aunt three separate times that he didn't want to die in a hospital bed wired to a machine. He had not written it down. The intensive care team did not know him. The family argued. The ventilator stayed. He died on the tenth day, not at home in the bed he wanted, not on the deck looking at the gum trees, but in a ward with the curtain pulled.

This isn't legal advice. It's a description of the document that would have changed those ten days, and the conversation that has to come with it.

The terminology, state by state

Australia calls this document by different names depending on where you live. They do roughly the same thing.

• NSW: Advance Care Directive (common law instrument, not statutory) plus the appointment of an Enduring Guardian
• Victoria: Advance Care Directive (statutory under the Medical Treatment Planning and Decisions Act 2016)
• Queensland: Advance Health Directive (statutory)
• WA: Advance Health Directive (statutory under the Guardianship and Administration Act 1990)
• South Australia: Advance Care Directive (statutory, combines health and personal matters)
• Tasmania: Advance Care Directive (common law plus Enduring Guardianship for substitute decisions)
• ACT: Health Direction (statutory)
• NT: Advance Personal Plan (statutory)

The American term "living will" is not formally used in Australian legislation, but it captures what these documents do: they're directions about your medical care that take effect when you can't speak for yourself.

The substance across states is similar. The form, the witnessing rules, and the legal weight differ. A statutory directive (Vic, Qld, WA, SA, ACT, NT) has explicit legal force under the relevant Act. A common law directive (NSW, Tas) draws its weight from the common law principle that a competent adult's prior expressed wishes about future treatment must be respected.

In practice, hospitals across Australia treat valid directives seriously. A clear, witnessed, dated directive that addresses the situation in front of the clinician is a powerful document.

What you can specify

The scope of an Advance Care Directive is wider than most people realise. You can:

• Refusal of specific treatments (mechanical ventilation, CPR, artificial nutrition, blood transfusion, dialysis, antibiotics in certain circumstances)
• Conditions on consent (only if there's a reasonable prospect of returning to a quality of life I would recognise)
• Preferences for palliative care (where, with whom, what level of sedation)
• Preferences for place of death (home, hospice, hospital)
• Cultural and spiritual preferences (religious observance, who is present, what is read)
• Values and goals statements (what matters to you about how you live and die)

You cannot:

• Demand a specific treatment that isn't clinically indicated
• Direct anyone to perform an act that's unlawful (including, in most states, voluntary assisted dying outside the specific VAD legislation)
• Override the law on emergency treatment for someone clearly in mental distress

The most useful directives I've seen do three things at once:

• Refusing specific interventions in specific circumstances (refuse CPR if I have advanced dementia and another life-threatening event occurs)
• Stating values that help clinicians and family interpret novel situations (I value lucidity over longevity, I would rather have shorter life with my mind intact than longer life without it)
• Naming a substitute decision-maker who knows you and will speak for you when the directive doesn't cover the exact situation

How to create one

The mechanical steps:

• Download your state's official form from the relevant health or justice department website (free, lawful, accepted by every hospital in your state)
• Read through the form before filling anything in. The questions guide the conversation
• Talk to your GP. Most GPs will spend a Medicare-rebated consultation working through the medical sections with you, and will note that the conversation occurred (which strengthens the directive's standing later)
• Talk to the person you'll nominate as substitute decision-maker. They need to agree, and they need to know what's in the document
• Sign and witness according to your state's rules. Witnessing requirements vary: some states require a medical practitioner, some require an authorised witness, some require two adult witnesses
• Lodge or store: every state has different rules about where the document goes. Some states have an electronic register. Most rely on you to give copies to your GP, your hospital of choice, your substitute decision-maker, and to keep the original somewhere accessible

The forms ask hard questions. That's the point. The form is doing the work of forcing the conversation that, in my uncle's family, never happened.

Where to lodge

Storage and registration vary by state.

• Victoria: directives can be uploaded to My Health Record (the federal electronic record), which is visible to any treating clinician with access
• Queensland: Queensland Health maintains a state register
• South Australia: Advance Care Directives can be lodged with SA Health
• NSW: no central register; reliance on My Health Record uploads and physical copies given to GP, family, and the patient's wallet
• WA: lodgement with the Office of the Public Advocate is possible
• Tasmania, ACT, NT: similar mix of My Health Record and physical distribution

Practical rule: every state respects a properly executed directive presented at the time of treatment. The question is whether the directive is found in time. A directive in your filing cabinet at home is useless when you're in an ambulance. A directive uploaded to My Health Record, and a card in your wallet stating its existence, and a copy with your GP, and a copy with your substitute decision-maker is a directive that does its job.

The Australian Digital Health Agency runs My Health Record. Uploading is free. The clinician at the hospital will see the document if they look. Make it easier for them to look by carrying a card.

The conversation that has to happen

The document is half the work. Maybe less than half.

A directive that refuses ventilation in the case of advanced dementia is meaningless if your wife has not been told that's what you want. She walks into the ICU. The doctor asks her what your wishes are. She says you never talked about it. The directive is somewhere at home in a folder. The ventilator goes on. The grief that follows includes a layer of self-reproach that compounds for years.

The conversation needs to cover:

• Specific scenarios you've thought about (severe stroke, advanced dementia, terminal cancer, persistent vegetative state)
• Your values: what makes life worth continuing for you, what doesn't
• Your preferences for setting (home if possible, hospice as second choice, hospital only as last resort)
• Who you trust to speak for you and why
• What you want them to do if the family disagrees

Have it more than once. Have it before the diagnosis, not after. Have it with your spouse, your adult children, your siblings if they're likely to be present. Have it with your GP. Write down the answers. Put them in the directive. Update the directive every five years or after any significant health event.

The body is the canvas these decisions are painted on. If you've watched a parent die well, you know what good care looks like. If you've watched a parent die badly, you know what to avoid. Use that. Don't waste the lesson.

The substitute decision-maker

The person you nominate needs three qualities:

• Knowledge of your values and preferences (not just love, knowledge)
• Capacity to advocate under pressure (clinicians can be persuasive, family members can be loud)
• Geographic and emotional availability (close enough to be present, calm enough to think)

Common choices:

• Spouse as primary (with the caveat that grief impairs judgment, so a substitute substitute matters)
• Adult child who has medical or care experience
• Sibling who shares your values
• Trusted friend, particularly if family relationships are complicated

The role is not about making decisions you didn't authorise. It's about interpreting your directive in situations the directive didn't anticipate, and standing by what you wrote when others want to override it.

I've seen substitutes hold the line in rooms full of relatives demanding everything be done. It's the hardest job in the family at the hardest moment, and it deserves more recognition than it gets.

What this is worth

A solicitor will charge perhaps two hundred dollars to draft a directive with you. Free templates exist for every state. The Medicare consultation with your GP costs you a gap fee at most. The total financial cost is under three hundred dollars.

The cost of not doing it is harder to count. It's the nine extra days my uncle spent on a ventilator. It's the fight between his daughters that took a decade to settle. It's the bushwalking memorial that happened with the wrong music because nobody had asked. It's the family Christmas where his name was the elephant in the room because nobody had agreed about what he would have wanted.

The directive doesn't make death easier. It makes the bad parts of dying smaller. WRITE this down. Then talk about it. Then sign it. Then live the rest of your life knowing it's done.

Plan now. Live easier.