In short

An Advance Care Directive is a written record of your medical treatment preferences, while a separately appointed personal decision-maker — an Enduring Guardian or equivalent, depending on the state — acts on those wishes if you lose capacity. Neither is covered by a financial enduring power of attorney, which deals only with money and property, so a complete plan needs both a financial and a personal/medical decision-maker alongside a will.

For retirees who have addressed their financial pre-emptive planning — enduring power of attorney, will, binding death benefit nomination — there is often a material gap on the medical side. Advance Care Directives and the appointment of an Enduring Guardian (or personal matters equivalent) address decisions that financial documents simply cannot. They are distinct instruments, designed for different purposes, and both matter.

An Advance Care Directive is a written document that records your preferences about medical treatment. Its purpose is to capture what you would want — and what you would not want — in circumstances where you can no longer communicate those preferences yourself. A well-prepared directive typically covers quality of life considerations, preferences around specific treatments such as resuscitation and life support, pain management, and end-of-life care. It can record the values and beliefs that should guide medical decisions in your name, and it can express preferences about where end-of-life care should be provided. The document does not have to be exhaustive to be useful — even a focused record of your priorities on a few key decisions is substantially better than nothing.

The complementary instrument is the appointment of a personal decision-maker: a person authorised to make medical and personal decisions on your behalf if you lose capacity. This role goes by different names in different states. In New South Wales it is the Enduring Guardian; in Victoria, the appointment is made under the Medical Treatment Planning and Decisions Act 2016, through a Medical Treatment Decision Maker appointment or the enduring power of attorney for personal matters framework; in Queensland, it is handled through an Enduring Power of Attorney covering personal and health matters under the Powers of Attorney Act 1998; other states have their own equivalents. The form, witnessing requirements, and scope of authority differ across jurisdictions. A document validly executed in one state may not be recognised in another, though mutual recognition between jurisdictions has been improving. Anyone who has moved interstate should check whether their existing document remains effective.

Each state and territory has its own ACD legislation (Advance Care Planning Australia maintains current state-by-state guidance at advancecareplanning.org.au; key statutes include Powers of Attorney Act 2014 (Vic), Guardianship Act 1987 (NSW), Powers of Attorney Act 1998 (Qld), Advance Care Directives Act 2013 (SA), Guardianship and Administration Act 1990 (WA), Guardianship and Administration Act 1995 (Tas), Powers of Attorney Act 2006 (ACT) and Advance Personal Planning Act 2013 (NT)). State legislative reform happens periodically — confirm current requirements for the relevant state with a specialist solicitor before drafting or relying on a directive.

The distinction between these medical instruments and the enduring power of attorney is important and frequently misunderstood. An enduring power of attorney covers financial decisions: managing bank accounts, selling property, dealing with Centrelink. It does not extend to medical or personal decisions unless the document specifically says so — and in some states, a single document cannot cover both. For comprehensive coverage, you generally need both a financial decision-maker (EPOA) and a personal/medical decision-maker (Enduring Guardian or equivalent), backed by an Advance Care Directive that records your actual wishes.

In terms of when these documents operate: an Advance Care Directive typically comes into effect when you lack capacity to make medical decisions — it provides guidance to medical professionals and to the appointed decision-maker at that point. The personal decision-maker appointment similarly activates on loss of capacity. Both are distinct from a will, which only operates after death, and from a BDBN, which covers the distribution of superannuation death benefits. The complete picture — will, BDBN, EPOA, personal decision-maker appointment, and Advance Care Directive — addresses the full range of eventualities that a retiree planning ahead should consider.

The practical process for putting these documents in place involves reflection, conversation, and execution. The reflection piece — thinking carefully about what matters to you, what treatment preferences you hold, what quality of life means to you — cannot be shortcut. The conversation with the person you are appointing as decision-maker is equally important: they need to understand your values well enough to make decisions under pressure that they believe you would have made yourself. A conversation with your GP can help translate personal preferences into clinically meaningful language — "I would not want life support if there is no reasonable prospect of recovery" is a preference that your GP can help you articulate in terms that medical staff will understand and can act on.

Execution requires state-specific forms and witnessing requirements. For most Australians, a solicitor specialising in elder law or estate planning is the right professional to prepare these documents, particularly if the personal circumstances involve complexity — a blended family, estranged relationships, or specific medical conditions that make detailed planning more important. Once executed, copies should go to your GP, your appointed decision-maker, and your regular hospital if you have one.

The common misconceptions in this space are consistent. Many retirees assume their family knows what they would want — but specific medical decisions in high-pressure situations are rarely things that family can predict accurately without explicit guidance. Others assume their GP will make the decisions — in practice, medical professionals facing a patient without an Advance Care Directive and without a nominated decision-maker are often in a genuinely difficult position, and family members who have not been formally appointed may find their authority questioned. And the assumption that a will covers these matters is incorrect: wills operate only on death, not during incapacity.

For retirees who have addressed financial planning thoroughly, the marginal effort required to complete the medical planning picture is modest. The value — to your own wishes being followed and to your family being spared unnecessary conflict and uncertainty — is substantial.

Sources

Key takeaways

  • An Advance Care Directive records your medical treatment preferences — quality of life, resuscitation, pain management and end-of-life care — for use when you can no longer communicate them yourself.
  • The personal decision-maker role that acts on those wishes goes by different names by state: Enduring Guardian in NSW, Medical Treatment Decision Maker in Victoria, and other equivalents elsewhere.
  • A financial enduring power of attorney covers money and property only — it does not extend to medical or personal decisions unless the document specifically says so.
  • Both the Advance Care Directive and the personal decision-maker appointment activate on loss of capacity, distinct from a will (which only operates after death) and a BDBN (which covers super death benefits).
  • A document validly executed in one state may not be recognised in another, so anyone who has moved interstate should check whether their existing document remains effective.

Frequently asked questions

What is the difference between an Advance Care Directive and a power of attorney?

An enduring power of attorney covers financial and legal decisions — bank accounts, property, dealing with Centrelink. It does not cover medical decisions unless specifically stated, and in some states can't. An Advance Care Directive records your own medical treatment wishes, separate from financial planning entirely.

Who makes medical decisions for me if I lose capacity and haven't appointed anyone?

Medical professionals facing a patient without an Advance Care Directive and without a nominated decision-maker are often in a genuinely difficult position, and family members who haven't been formally appointed may find their authority questioned.

Does my will cover medical decisions if I lose capacity?

No. A will only operates after death — it has no effect during incapacity. Medical and personal decisions during incapacity are covered by an Advance Care Directive and a separately appointed personal decision-maker (Enduring Guardian or equivalent).

Is an Advance Care Directive from one state valid if I move interstate?

Not necessarily. Each state and territory has its own legislation, form, and witnessing requirements, and a document validly executed in one state may not be recognised in another, though mutual recognition has been improving. Check your existing document remains effective after an interstate move.

A note on advice. This article is general information only and doesn't account for your personal circumstances. Everyone's situation is different — before acting, it's worth talking it through with a licensed adviser who knows your full picture.