How to Make an Advance Care Directive in Tasmania

The Legal Framework You Are Working Within

Tasmania's statutory Advance Care Directive framework came into effect on 21 November 2022 under Part 5A of the Guardianship and Administration Act 1995. Before this, Tasmanians could make common law advance directives, but they had no formal registration pathway and their enforceability depended on case-by-case clinical interpretation.

The 2022 framework created a specific instrument — the statutory ACD — that carries binding legal force when properly made. A valid ACD must be completed on the approved Tasmanian Health Service form, witnessed correctly, and ideally registered with TASCAT. Here is how to work through each step.

Step 1: Confirm Your Decision-Making Capacity

Under Tasmanian law, every adult is presumed to have decision-making capacity unless there is evidence otherwise. To make a valid ACD, you must be able to:

• Understand the medical information relevant to the decisions you are recording
• Retain that information long enough to weigh the options
• Weigh the potential outcomes of each choice
• Communicate your decisions (verbally, in writing, or through an interpreter)

If you have received a cognitive diagnosis — early-stage dementia, for example — capacity may still be present. The diagnosis itself does not disqualify you. However, it is worth asking your GP to conduct a formal capacity assessment and record it in your clinical file. That written medical note, stored alongside your ACD, provides protection against future legal challenges from family members who might argue you were not competent when you signed.

Step 2: Get the Correct Form

You must use the approved ACD form published by the Tasmanian Health Service. No other template, online form, or interstate equivalent is accepted for statutory registration.

Download the form from the Department of Health website (search for "Advance Care Directive Tasmania" on the health.tas.gov.au site). If you cannot access the form online, request a printed copy from your GP, local hospital, or Service Tasmania outlet.

The form is divided into sections covering:

• Your personal details
• Your values and what matters most to you
• Specific treatment consents and refusals
• Conditions or circumstances that would trigger your refusals
• Your signature and witness declarations

Step 3: Draft Your Treatment Preferences

This is where most people get into trouble. The tendency is to write vague statements like "I do not want to be kept alive by machines" or "no extraordinary measures." These phrases have no clinical definition, and treating doctors cannot execute them during an emergency.

Instead, your ACD should map directly to the clinical categories used by Tasmanian hospitals. The Tasmanian Health Service uses a Medical Goals of Care (GOC) Plan with four phases:

• Phase A — Full active treatment including CPR
• Phase B — Active treatment with specific limits (e.g., "Not for CPR" or "Not for intubation")
• Phase C — Palliative focus, comfort-oriented care, no CPR or intubation
• Phase D — Comfort care only during the dying process

When you write your refusal clauses, think in terms of these clinical categories. Instead of "no life support," specify exactly which interventions you are refusing and under what circumstances. For example: "If I have a terminal illness with no reasonable prospect of recovery, I refuse cardiopulmonary resuscitation, mechanical ventilation, and artificial nutrition or hydration."

One critical point: CPR and intubation are clinically inseparable. A person whose heart has stopped is not breathing independently — chest compressions require airway management. Requesting CPR but refusing intubation creates a medical contradiction that clinicians cannot execute, and they will default to full active treatment.

Step 4: Arrange Witnessing

Your ACD requires two independent adult witnesses. Both must be present simultaneously when you sign. The list of people who are disqualified is specific — close relatives, your Enduring Guardian, paid carers, residential facility staff, anyone who helped fill out the form, and estate beneficiaries are all ineligible.

Good witness choices include neighbours, colleagues, Justices of the Peace, or a pharmacist.

For the full witnessing rules and disqualification criteria, see our detailed breakdown.

Step 5: Sign and Have It Witnessed

The correct order is:

1. You sign the ACD in the presence of both witnesses
2. Both witnesses sign, certifying that you appeared to understand the nature and effect of the document
3. If an interpreter was used, they sign a certification of accuracy

All signatures must happen at the same session. You cannot sign in front of one witness today and the second next week.

Step 6: Register with TASCAT (Optional but Strongly Recommended)

Registration with the Tasmanian Civil and Administrative Tribunal is free and creates a permanent, searchable record. This means hospital staff can verify your directive exists and retrieve its contents during a medical emergency — even if your physical copy is not immediately available.

To register:

1. Complete the TASCAT Application for Registration of an Advance Care Directive form
2. Submit the original ACD and the application form to TASCAT (by post or through the online portal)
3. Wait for TASCAT's registration confirmation, then keep it with your ACD and distribute the registered copy as needed

Even without registration, a properly made ACD is legally binding. But registration removes the risk that your directive is lost, inaccessible, or disputed.

Step 7: Distribute Copies and Upload to My Health Record

Once your ACD is made (and ideally registered), distribute copies to:

• Your GP, who should flag it in your patient file
• Your appointed Enduring Guardian
• Your closest family members
• Any specialist who manages an ongoing condition
• Your residential aged care facility (if applicable)

You should also upload the directive to your My Health Record through your MyGov account. This makes it instantly accessible to emergency physicians, hospital admitting teams, and ambulance paramedics anywhere in Australia — not just in Tasmania.

What Happens After You Make It

An ACD is not a set-and-forget document. Your medical circumstances, personal values, and family situation change over time. Review your ACD at least annually and after any major health event — a new diagnosis, a hospitalisation, or a significant change in your care needs.

If you need to change your ACD, you cannot amend the existing one. You must revoke the old directive and execute a new one from scratch. The old ACD must be formally revoked with notice to TASCAT (if registered) to prevent clinicians from relying on outdated instructions.

Pulling It All Together

Making an ACD is one piece of a complete Tasmanian advance care plan. You will also want an Enduring Guardian (for someone to make decisions when you cannot) and an Enduring Power of Attorney (for financial decisions). Each instrument has its own form, its own registry, and its own rules.

The Tasmania Advance Directive & Living Will Kit walks through all three instruments in the correct sequence, with clinically precise refusal language that maps directly to hospital GOC categories, witness verification sheets, and the split-registry filing guides for TASCAT and the Land Titles Office.

See more Tasmania guides →