Advance Care Plan NZ: How to Record Your Healthcare Wishes

An advance care plan records what medical treatment you do and don't want if you lose the ability to speak for yourself. In New Zealand, a separate advance directive can have legal force under the Code of Health and Disability Services Consumers' Rights — specifically Right 7(5), which can make a properly executed refusal of specific treatment binding on clinicians. An advance care plan itself is broader guidance, not a legally binding directive.

Are Advance Care Plans Legally Binding in NZ?

An advance care plan itself is not legally binding. A separate advance directive can be binding under the Code of Rights:

• Refusals of specific treatment in a valid advance directive are binding. If you're a competent adult and you refuse a particular treatment in writing, that refusal must be respected by healthcare providers once you lose capacity — provided the directive applies to the clinical circumstances and was validly executed.
• Requests for treatment are not binding. You can express a wish to receive certain treatments, but clinicians aren't obligated to provide treatment they consider clinically inappropriate.

This distinction matters. A directive that says "I refuse mechanical ventilation if I have an irreversible neurological condition" has legal force. A directive that says "I want all possible life-sustaining treatment" is a preference that clinicians will consider but can override based on clinical judgement.

Advance Care Plans vs EPAs

These overlap in purpose but work differently:

An advance care plan is your broader voice. It records your values, preferences, and treatment goals for your healthcare team, but it is not legally binding by itself. A separate advance directive can record specific treatment refusals that are binding under Right 7(5).

A welfare EPA (Enduring Power of Attorney for Personal Care and Welfare) appoints someone to make decisions on your behalf when you can't. Under the PPPR Act 1988, a welfare attorney can consent to or refuse medical treatment for you — but they're supposed to make decisions consistent with your known wishes.

The strongest position is having both: an advance care plan that records your broader preferences, and a welfare EPA that appoints someone to handle situations your plan didn't anticipate. When these documents agree, clinicians have clear guidance. If a separate advance directive conflicts with the welfare EPA, the valid directive prevails for the specific treatment it covers; the welfare EPA handles other decisions.

What to Include

A useful advance care plan covers:

Values and priorities. What matters most to you — independence, comfort, being at home, being with family, quality of life versus length of life. These guide decisions in situations your specific instructions don't cover.

Treatment preferences. Your position on mechanical ventilation, CPR, feeding tubes, dialysis, blood transfusions, and other interventions. Be as specific as possible about the conditions under which you would or wouldn't want each intervention.

Pain management. Whether you prioritise pain relief even if it may shorten life, or prefer to maintain consciousness even if it means more discomfort.

End-of-life setting. Whether you'd prefer to die at home, in a hospice, or in hospital.

Cultural and spiritual considerations. Any tikanga, religious practices, or cultural protocols that should guide your care — particularly relevant for whānau Māori arranging tangihanga or other cultural practices.

How to Make One

1. Start the conversation with your GP. Your general practitioner can help you understand your health trajectory and which decisions are most relevant to plan for. Hospice New Zealand and the Health Quality & Safety Commission provide free planning booklets and templates.

2. Write it down. Use a structured template (the HQSC "My Advance Care Plan" template is widely used in the NZ health system) or write your own document. Be specific about treatments and conditions.

3. Share it. Give copies to your GP (who records it in your patient file), your welfare attorney, your family, and anyone likely to be involved in your care. A plan that nobody can find when it's needed is the same as having no plan.

4. Review it. Your preferences may change after a health event, a diagnosis, or simply with time. Review annually or after any significant health change.

The End of Life Choice Act 2019 Limitation

One thing you cannot do in an advance care plan: request assisted dying. Under the End of Life Choice Act 2019, a person must be competent and able to make an informed decision at the time they make an assisted dying request. An advance directive requesting euthanasia has no legal effect.

Putting It All Together

An advance care plan works best as part of a coordinated set of documents — alongside your will, your EPAs, and a central document inventory that tells your family where everything is stored. Our New Zealand End-of-Life Planning Guide provides templates for all of these and walks through how to make your healthcare preferences consistent with your broader estate plan.

See more New Zealand guides →