Advance Care Directive Victoria: How to Make One That Actually Works

What an Advance Care Directive Actually Does in Victoria

An advance care directive (ACD) is the only document in Victoria that lets you record legally binding medical treatment decisions in advance. Under the Medical Treatment Planning and Decisions Act 2016, which commenced on 12 March 2018, a valid ACD is binding on health practitioners — meaning a doctor must follow your documented instructions even if your family disagrees or the treating team would prefer a different course of action.

This is stronger protection than most Australian states offer. In Victoria, your written directive sits above clinical judgement and above family wishes in the decision-making hierarchy. That authority is precisely why the execution requirements are strict.

The Two Types of Directive You Can Include

Victorian ACDs can contain one or both of the following:

Instructional directives are specific, binding orders. They tell clinicians exactly what to do or refuse in defined medical scenarios — for example, refusing CPR, declining mechanical ventilation, or consenting to organ donation. Clinicians must follow these as if you were making the decision in real time.

Values directives describe your preferences, priorities, and what a good outcome looks like to you. These guide your Medical Treatment Decision Maker (MTDM) when a situation arises that your instructional directives don't cover. Values directives aren't binding in the same way — they inform rather than command — but they carry significant weight in clinical decision-making.

Most effective ACDs include both. The instructional component handles clear-cut scenarios. The values component gives your MTDM the context to handle everything else.

Who Can Make One

Any adult (18 or older) with decision-making capacity can create an ACD. Capacity is presumed under Victorian law — nobody needs to prove they're competent before they start. However, if you have a cognitive condition (early-stage dementia, acquired brain injury, psychiatric illness), it's worth getting a formal capacity assessment from your GP before signing. This creates a contemporaneous record that protects the directive from later challenges by family members.

How to Complete the Form

The statutory form is available as a free PDF download from the Victorian Department of Health (health.vic.gov.au/advance-care-planning/forms). The Office of the Public Advocate also provides detailed guidance documents.

Here's the practical sequence:

1. Download the form and read the Department of Health instructions document alongside it.
2. Book a GP appointment specifically to discuss your ACD — not tacked onto a regular consultation. This serves two purposes: the GP helps you translate personal values into unambiguous clinical language, and they'll be one of the two required witnesses when you sign.
3. Draft your instructional directives using precise medical terminology. Vague statements like "no heroic measures" are difficult for clinicians to interpret. Instead, specify: "I refuse cardiopulmonary resuscitation" or "I consent to a trial of mechanical ventilation for a maximum of 72 hours."
4. Write your values directive describing what matters to you — independence, cognitive function, connection with family, staying at home — and what outcomes would be unacceptable.
5. Arrange signing with two witnesses, one of whom must be a registered medical practitioner (your GP). Neither witness can be someone you've appointed as your MTDM. All parties must be physically present in the same room — remote or video witnessing is not permitted for ACDs in Victoria.

The GP Witnessing Requirement

This is the most common practical barrier. Victoria requires that one of your two witnesses be a registered medical practitioner — a medical doctor with current AHPRA registration. The doctor doesn't just watch you sign; they must verify that you understand the document and its implications, particularly that instructional directives are legally binding on treating teams.

Many GPs are unfamiliar with the 2016 Act and may hesitate. Some charge administrative fees of $100 to $300 for the appointment since this witnessing service is not covered by Medicare. A few practical strategies:

• Book a dedicated long appointment (at least 30 minutes) and explain in advance that you need a witnessed ACD signing.
• Bring the completed form and the Department of Health instructions so the GP can review the statutory requirements.
• If your regular GP declines, contact the advance care planning team at your local public hospital or community health centre — many run dedicated ACD clinics.

What Happens After You Sign

Victoria does not have a central registry for ACDs. You are responsible for distributing copies to ensure the document is available when it matters:

• Give a certified copy to your GP for your patient file.
• Provide a copy to your local hospital's medical records department.
• Upload a scanned copy to your My Health Record (myhealthrecord.gov.au).
• Give the original to your appointed MTDM and tell them where to find it.
• Keep a copy with your other important legal documents.

Review your ACD every two years, or whenever your health status changes significantly. An outdated directive may be treated as a values statement rather than a binding instruction.

Common Mistakes That Invalidate the Document

The most frequent problems are procedural, not substantive:

• Wrong witnesses: both witnesses must be adults, neither can be your MTDM, and one must be a medical practitioner. Miss any of these and the directive is invalid.
• Video or phone witnessing: not permitted for ACDs. You and both witnesses must be physically present in the same room.
• Vague medical language: "no extraordinary measures" means different things to different clinicians. Use specific treatment names.
• Forgetting the MTDM appointment: the ACD and the MTDM appointment are separate documents. An ACD alone doesn't appoint someone to make decisions on your behalf — it only records your own instructions.

Getting It Right the First Time

The Victorian ACD framework is powerful precisely because it's legally binding. That binding nature also means the execution requirements are strict — a small procedural error can render the entire document unenforceable.

The Victoria Advance Directive & Living Will Kit walks through the entire process with clinician-approved phrasing templates, a GP consultation script, and a signing checklist designed specifically for the 2016 Act requirements. It bridges the gap between the blank government form and a fully effective, binding directive.

See more Victoria guides →