Evidence & Issues

Legislative framework in Australia
For a discussion of the aims and principles of advance care planning, see the NSW document Using Advance Care Directives (March 2005).

For detailed discussion of the issues underlying development of legislation in this area, and a description of each state’s legislative framework and approach, go to the WA Department of Health publication: Discussion Paper – Medical Treatment for the Dying 2005.

For a comparison between the various state approaches and a discussion of the obligations of doctors with regard to advance directives, see the article in the Medical Journal of Australia, “Determining the Validity of Advance Directives".

New developments in Australia
Respecting Patient Choices is a program to support advance care planning, which started in Victoria in 2000 and is currently being extended to other States.

Other evidence regarding advance care planning
There is little evidence at the level of RCTs or systematic reviews, but plenty of literature on the topic overall.

Some of the topics being investigated in the literature are …

The extent to which advance directives actually influence care
Application of advance directives in residential aged care facilities
Information needs of patients completing advance directives, and whether specific additional information changes people’s opinions about their future care
Patients’ perspectives on discussing end of life issues, barriers to using advance directives, preferences for more or less detailed plans and for more or less involvement in decision-making, and differences between different cultural groups
Whether advanced directives reduce health expenditure
What kinds of system changes and education are needed to improve end of life decision-making

Controversial issues
Much publicised cases lead to media discussion about end of life decision making processes, and the associated ethical and legal issues. For a review of these debates from the palliative care perspective, see the article “Resolving conflict in end-of-life care” by Ashby M, Kellehear A and Stoffell B MJA 2005, 183(5): 230 - 231.

Issues which limit the usefulness and appropriateness of advance directives are discussed in the article by Jordens C, Little M, Kerridge I and McPhee J From advance directives to advance care planning: current legal status, ethical rationales and a new research agenda Internal Medicine Journal 2005; 35: 563-566.

This page was created in January 2006 and due for review in January 2008
Last updated 5 September 2007