Medical Power of Attorney South Australia: Why SA Uses a Different System

South Australia No Longer Creates New Medical Powers of Attorney

If you're searching for how to set up a medical power of attorney in South Australia, you need to know upfront: SA no longer creates a new standalone document of that kind.

On 1 July 2014, South Australia replaced three separate planning instruments — the Medical Power of Attorney, the Enduring Power of Guardianship, and the Anticipatory Direction — with a single document called the Advance Care Directive (ACD), governed by the Advance Care Directives Act 2013.

That means you can't create a standalone "medical power of attorney" in SA. What you can do is appoint a Substitute Decision-Maker (SDM) within your ACD, which gives someone you trust the legal authority to make healthcare, lifestyle, and accommodation decisions on your behalf if you lose capacity.

What a Substitute Decision-Maker Actually Does

An SDM under an ACD is broader than the old medical power of attorney ever was. Your SDM can make decisions about:

• Healthcare treatments — consenting to or refusing surgery, chemotherapy, blood transfusions, or other medical interventions
• Living arrangements — deciding whether you stay at home, move into residential aged care, or transfer between facilities
• Personal and lifestyle choices — daily routines, social activities, and personal care preferences

You can appoint up to four SDMs and rank them in order of preference. If your first-preferred SDM is unavailable or unwilling, the next person on the list steps in automatically.

There's one hard boundary: your SDM cannot make financial or property decisions. Those powers require a completely separate Enduring Power of Attorney (EPA) under the Powers of Attorney and Agency Act 1984.

Who Makes Decisions If You Don't Have an ACD?

If you lose capacity without an ACD in place, the Consent to Medical Treatment and Palliative Care Act 1995 kicks in. This statute establishes a rigid hierarchy of who can consent to medical treatment on your behalf — what the law calls the "Person Responsible":

1. A SACAT-appointed guardian with healthcare powers
2. A prescribed relative with a close, continuing relationship (including a spouse, domestic partner, or adult related by blood, marriage, adoption, or Aboriginal/Torres Strait Islander kinship rules)
3. An adult friend with a close, continuing relationship
4. The person responsible for your day-to-day care (such as an aged care facility director)
5. SACAT itself, as a tribunal of last resort

The problem with this default hierarchy is obvious: you don't get to choose. Your estranged spouse might outrank the sibling who actually knows your values. A facility manager you've never met might end up deciding whether you receive CPR.

An ACD lets you bypass this entire hierarchy by naming exactly who should speak for you.

How the ACD Differs from Interstate Medical Powers of Attorney

Other Australian states still use separate documents. In Victoria, you'd sign a medical treatment decision maker appointment alongside an advance care directive. In Queensland, you'd create an enduring power of attorney that covers both health and financial matters.

South Australia's consolidated approach has practical advantages. Because health, lifestyle, and accommodation decisions all sit in a single document, there's no risk of conflicting instructions across multiple forms. Clinicians check one document, not three.

The trade-off is that the ACD's strict execution requirements — SDMs must sign their acceptance before the principal signs, an authorized witness from a specific list of professions must oversee the final signing — make it more procedurally demanding than some interstate equivalents.

Setting Up Your ACD Instead

The official ACD form is free. You can download it from the SA Health website, pick up a hardcopy at any Service SA centre, or collect one from selected public libraries and MPs' offices. Make sure you're using the redesigned form published after 1 March 2024, which reflects the latest amendments to the Act.

The critical steps:

1. Draft your instructions — record your healthcare preferences, treatment refusals, and values. Be specific: "no mechanical ventilation if I have an irreversible brain injury with no prospect of meaningful recovery" is far more enforceable than "no heroic measures."
2. Appoint your SDMs — name up to four people, in ranked order, and discuss your wishes with each of them.
3. Get SDM signatures first — each SDM must sign their acceptance section before you sign the document.
4. Sign before an authorized witness — the witness must be a JP, legal practitioner, registered health practitioner, social worker, police officer, or teacher. Family members, beneficiaries of your will, and your treating doctor are all disqualified.

What About the Financial Side?

Because the ACD strictly excludes financial and property decisions, you'll also need an Enduring Power of Attorney if you want someone managing your bills, bank accounts, or real estate should you lose capacity. The EPA is a separate document under different legislation.

Most South Australians completing their ACD should complete an EPA at the same time — the two documents together cover the full spectrum of decision-making that a single "power of attorney" might cover in other jurisdictions.

Our South Australia Advance Directive & Living Will Kit walks you through both documents, including the clinically precise language that ensures your treatment refusals are legally binding — not just aspirational wishes that clinicians can set aside.

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