Goals of Patient Care WA: How GOPC Works in Western Australia

Two Documents That Look Similar but Work Completely Differently

Families in Western Australia routinely confuse the Goals of Patient Care (GOPC) form with an Advance Health Directive (AHD). They both deal with medical treatment decisions. They both appear on hospital charts. But they are fundamentally different instruments, and misunderstanding them can lead to treatment outcomes nobody intended.

The AHD is a statutory legal document you complete in advance, at home, while you have full capacity. It records your binding treatment decisions under Part 9B of the Guardianship and Administration Act 1990. Once validly executed, it takes precedence over everyone — including doctors and family members — subject to the limited statutory exceptions.

The GOPC is a clinical medical order completed by the treating team during a specific hospital admission. It is not a legal document. It does not carry statutory force. It documents the agreed clinical "ceiling of care" for the current episode — for example, whether CPR should be attempted, whether ICU transfer is appropriate, or whether the focus should shift entirely to comfort-based palliative care.

How the GOPC Is Completed

When a patient is admitted to a WA public hospital — or when their clinical condition changes significantly during an existing admission — the treating doctor initiates a GOPC discussion. The conversation follows a structured framework:

1. Establish the baseline. The clinician reviews the patient's diagnosis, prognosis, and any existing AHD or EPG. If the patient has an AHD that addresses the relevant treatment decisions, those documented instructions take precedence.

2. Explore the patient's values. If the patient has capacity, the doctor asks directly about their priorities — whether preserving cognitive function matters more than extending life, for instance. If the patient lacks capacity, the doctor consults the first available person on the statutory hierarchy of treatment decision-makers (an enduring guardian or guardian with authority, then spouse or de facto partner, adult children, parents, siblings, a primary unpaid carer, and another person with a close personal relationship).

3. Set the clinical ceiling. Based on the medical facts and the patient's values (or their substitute decision-maker's input), the doctor documents specific orders: "for CPR," "not for ICU admission," "for comfort measures only," or similar clinical directives.

4. Record it on the form. The completed GOPC is filed in the patient's hospital medical record. Nursing staff, paramedics, and other clinicians treating the patient can then act on it immediately without needing to locate and interpret a separate legal document.

What Happens When a GOPC and an AHD Conflict

This is simpler than people expect. The AHD wins — it is the statutory instrument. If you have recorded in your AHD that you refuse mechanical ventilation in the event of a terminal illness, a GOPC cannot override that refusal, subject to the limited statutory exceptions.

However, the GOPC can add specificity in areas the AHD does not cover. Your AHD might refuse ventilation but say nothing about IV antibiotics. The GOPC addresses that gap for the current admission, based on a real-time conversation with you or your substitute decision-maker.

In practice, well-functioning hospitals reconcile the two at admission: the medical team reads the AHD, uses it as the foundation, and builds the GOPC around it for the clinical decisions the AHD is silent on.

Residential Goals of Care (RGOC)

The aged-care equivalent of the GOPC is the Residential Goals of Care (RGoC) form, used in WA residential aged-care facilities. It serves the same function — documenting a clinical ceiling of care — but is designed for the longer-term setting of residential care rather than the acute, time-pressured context of a hospital admission.

The RGoC is typically completed during or shortly after admission to the facility, reviewed at regular intervals, and updated whenever the resident's condition changes. Like the GOPC, it does not override a valid AHD.

Why This Distinction Matters for Families

Three practical consequences:

1. A GOPC applies to the current episode of care. When you are discharged and readmitted, a new GOPC discussion should happen. Your AHD, by contrast, remains in force across all future admissions (unless revoked or "read down" after ten years).

2. A GOPC requires someone to participate in the conversation. If the patient cannot speak for themselves and has no AHD, the doctor needs to find a substitute decision-maker — the enduring guardian under an EPG, or a family member from the statutory hierarchy. If nobody is available or if family members disagree, the decision can stall or escalate to the State Administrative Tribunal. Having an AHD in place means the treatment decisions are already documented, reducing the burden on family members at the worst possible moment.

3. Paramedics prioritise the GOPC in emergencies. In the immediate chaos of a resuscitation event, paramedics and emergency clinicians act on the clinical orders in front of them — the GOPC or RGoC form in the patient's chart. They do not have time to locate, read, and interpret a multi-page AHD stored in a filing cabinet. This is exactly why uploading your AHD to My Health Record matters: it can make the directive available electronically to treating healthcare professionals who access it.

Getting Both Documents Working Together

The strongest position is having a valid AHD that records your foundational treatment decisions, combined with the understanding that any hospital or aged-care facility will layer a GOPC or RGoC on top for the clinical specifics of each admission. The AHD is the floor. The GOPC is the real-time clinical response built on top of it.

The Western Australia Advance Directive & Living Will Kit includes a detailed comparison of AHD and GOPC frameworks, clinical ceiling-of-care discussion prompts, and a hospital-admission preparation checklist so your directive actually reaches the treating team.

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