How the UK's Advance Decisions Compare to Australia's Advance Health Directives

Advance care planning documents, while serving the same fundamental purpose worldwide, vary significantly in terminology, legal requirements, and implementation across different healthcare systems. As an advance care planning specialist who has worked with both UK and Australian systems, I've observed how these differences can impact individuals and families navigating end-of-life care decisions.

Terminology: Different Names for Similar Concepts

In the United Kingdom, the primary legal document for refusing specific medical treatments is called an "Advance Decision to Refuse Treatment" (ADRT), sometimes simply referred to as an "Advance Decision." Alongside this, individuals often create an "Advance Statement" outlining broader care preferences and values.

Australia, conversely, typically uses "Advance Health Directive" (AHD) or "Advance Care Directive" (ACD), though terminology varies between states and territories. Queensland and Western Australia use "Advance Health Directive," while South Australia uses "Advance Care Directive," and Victoria refers to "Advance Care Directives" within their Medical Treatment Planning and Decisions Act.

This terminology difference reflects deeper distinctions in how these healthcare systems approach advance care planning conversations and documentation.

Legal Frameworks: Statutory vs. Common Law Recognition

The UK's advance decisions framework operates under the Mental Capacity Act 2005, which provides statutory recognition for these documents throughout England and Wales (Scotland and Northern Ireland have similar but distinct legislation). This Act established clear criteria for valid advance decisions, particularly regarding life-sustaining treatment refusals.

Australia's legal framework is more complex due to its federal system. Each state and territory has developed its own legislation governing advance care directives, creating a patchwork of requirements across the country. South Australia's Advance Care Directives Act 2013 and Queensland's Powers of Attorney Act 1998 exemplify these jurisdiction-specific approaches.

Scope and Content: What These Documents Cover

UK advance decisions focus primarily on treatment refusals rather than positive requests for specific interventions. They become particularly significant for refusing life-sustaining treatments, which must be explicitly stated and specifically referenced in the document. The NHS provides guidance emphasising that advance decisions cannot request illegal interventions like assisted dying.

Australian advance health directives typically offer broader scope, often allowing individuals to express preferences for receiving certain treatments alongside refusals. Many Australian jurisdictions also incorporate values statements directly into their statutory forms, encouraging individuals to articulate the beliefs and priorities that should guide interpretation of their directives.

Digital platforms like Evaheld help navigate these differences for individuals with connections to both countries, ensuring documentation meets requirements in relevant jurisdictions.

Witnessing Requirements: Ensuring Validity

Witnessing requirements represent one of the most significant practical differences between these systems.

In the UK, advance decisions don't always require witnesses—except when refusing life-sustaining treatment, which must be witnessed and include the specific statement that the directive applies "even if life is at risk." This relatively straightforward approach makes documentation more accessible, though research suggests that witnessed documents generally receive greater recognition from healthcare providers.

Australian requirements are typically more stringent. Most states require multiple witnesses, often with specific qualifications. For example:

• Queensland requires a doctor to certify understanding and capacity
• Victoria requires two adult witnesses, one being a medical practitioner
• Western Australia requires two independent witnesses who aren't healthcare providers or beneficiaries in the person's will

These stricter requirements aim to ensure genuine informed consent but can create barriers to completion, as noted in Australian research published in the Medical Journal of Australia.

Substitute Decision-Makers: Different Approaches

Both systems allow appointment of substitute decision-makers, but with different mechanisms and terminology.

The UK uses Lasting Power of Attorney for Health and Welfare (LPA) to appoint someone to make healthcare decisions. This is a separate document from the Advance Decision and must be registered with the Office of the Public Guardian to become legally effective.

Australian jurisdictions use various terms for similar roles—Enduring Guardian (NSW), Medical Treatment Decision Maker (Victoria), or Attorney for Personal Matters (Queensland). In some states, this appointment can be incorporated directly into the advance care directive document, while others require separate forms.

The relationship between these substitute decision-makers and advance directives also differs subtly. In the UK, a valid and applicable advance decision takes precedence over the decisions of an LPA. In some Australian jurisdictions, the appointed decision-maker has greater interpretive authority when applying the directive to specific medical situations.

Storage and Accessibility: Critical Differences

For advance care planning documents to be effective, they must be accessible when needed—an area where both systems face challenges.

The UK lacks a centralised registry for advance decisions, creating accessibility barriers. While individuals are encouraged to share copies with their GP, healthcare proxy, and family members, these documents frequently remain unavailable during emergencies. The Coordinate My Care initiative in London represents one attempt to address this gap for a specific region.

Some Australian states have developed more systematic approaches to document storage. South Australia maintains an Advance Care Directive Registry, while Queensland has integrated advance health directives into their Queensland Health Electronic Medical Record. However, challenges remain with cross-state recognition and accessibility.

Evaheld's digital platform addresses these accessibility issues by providing secure storage with emergency access across both UK and Australian healthcare systems.

Cultural Context and Implementation

Beyond formal legal requirements, cultural attitudes significantly influence how advance care planning documents function in practice.

The UK's healthcare system has embedded advance care planning within broader initiatives like the Gold Standards Framework for end-of-life care, creating relatively consistent implementation in healthcare settings. The focus tends toward pragmatic documentation of specific treatment refusals.

Australia has developed a more holistic approach through initiatives like Advance Care Planning Australia, emphasising values-based conversations alongside documentation. This approach often encourages deeper exploration of personal preferences and cultural considerations that might influence care decisions.

Practical Considerations for International Families

For individuals with connections to both countries, several practical considerations emerge:

1. Document recognition: UK advance decisions may not be automatically recognised in Australian healthcare settings and vice versa, though they may still inform care discussions.
2. Jurisdiction-specific requirements: Consider completing documentation that meets requirements in each relevant jurisdiction where you might receive care.
3. Digital accessibility: Ensure documents are securely stored yet readily accessible across international boundaries. Evaheld provides solutions designed specifically for this international context.
4. Regular reviews: International differences make regular review particularly important when spending time in multiple jurisdictions.

For guidance tailored to your needs, explore trusted dementia help sites, resources on family legacy preservation, online wills and estate planning platforms, and dedicated advance care directive resources. You’ll also find expert guidance and secure Evaheld Legacy Vault services, along with valuable information for nurses supporting end-of-life planning and values-based advance care planning. Evaheld is here to ensure your future planning is secure, meaningful, and deeply personal — with family legacy preservation resources designed to support your advance care planning, and those closest to you: families, carers, and communities.

Conclusion

While UK advance decisions and Australian advance health directives serve similar purposes, their differences reflect distinct legal systems and cultural approaches to healthcare decision-making. Understanding these nuances becomes particularly important for individuals with connections to both countries.

Regardless of terminology and specific requirements, both systems fundamentally aim to respect individual autonomy and ensure healthcare aligns with personal values when patients cannot speak for themselves. By understanding the particular requirements in your jurisdiction—or multiple jurisdictions for international families—you can create effective advance care planning documents that will be recognised and honoured when needed most.

For those navigating between these systems, Evaheld offers country-specific guidance, secure international document storage, and accessibility features designed to bridge these different advance care planning frameworks.