NSW Advance Care Directive Form: How to Fill It Out Correctly
Why There Is No Official NSW Advance Care Directive Form
New South Wales is the only Australian state without a statutory advance care directive. While Queensland, Victoria, and South Australia each have government-mandated forms backed by specific legislation, NSW relies on common law to enforce your healthcare preferences. That means there is no single "correct" form you must use — but it also means a poorly written directive can be ignored at the bedside.
NSW Health publishes a recommended booklet called "Making an Advance Care Directive," which functions as the closest thing to an official template. It is not a statutory form, though. Its value lies in giving clinicians a familiar format they already recognise when reviewing patient files. Using a recognisable structure increases the chance that emergency staff will locate and follow your instructions rather than defaulting to full intervention.
What Your Directive Must Include to Be Enforceable
Under NSW common law, an advance care directive is legally binding when three conditions are met. You must have had decision-making capacity at the time you wrote it. Your instructions must be clear, specific, and unambiguous. And the directive must apply to the actual clinical scenario the medical team is facing.
The landmark case Hunter and New England Area Health Service v A [2009] NSWSC 761 established that NSW courts will uphold a directive that meets these criteria — and that a clear, valid directive is binding on treating clinicians. Vague language like "no heroic measures" fails this test because it does not tell a treating clinician which specific interventions you are refusing.
Step-by-Step: Filling Out Your Directive
Section 1: Personal Details and Capacity Statement
Record your full legal name, date of birth, address, and Medicare number. Include a dated statement confirming you are making this directive voluntarily and understand its consequences. If you have a current diagnosis that affects cognition (early-stage dementia, for example), consider having your GP sign a separate capacity assessment letter on the same date.
Section 2: Your Values and Goals of Care
This section captures what a good life looks like to you and the outcomes you consider worse than death. Be specific. Instead of writing "I value quality of life," state something like: "If I develop advanced dementia and can no longer recognise my family members, I do not want life-prolonging interventions including CPR, mechanical ventilation, or artificial nutrition via PEG tube."
Section 3: Treatment-Specific Decisions
Address each major intervention category with a clear consent or refusal:
- Cardiopulmonary resuscitation (CPR): State whether you consent to or refuse CPR, and under what circumstances. A conditional refusal might specify: "I refuse CPR if my treating doctor assesses that the likely outcome is survival with severe neurological impairment."
- Mechanical ventilation: Distinguish between short-term ventilation (hours to days, for a reversible condition) and long-term life-support ventilation.
- Artificial nutrition and hydration: Specify whether you consent to nasogastric tubes or PEG tubes if you permanently lose the ability to swallow.
- Antibiotics for life-threatening infection: Some people refuse antibiotics for pneumonia in the context of terminal illness while accepting them for minor infections.
- Dialysis: Relevant if you have existing kidney disease or are at risk of renal failure.
- Blood transfusions: Include if religious or personal beliefs affect your position.
Section 4: Organ and Tissue Donation
Record your position on organ donation clearly. Organ and tissue donation involves separate NSW Health procedures and family-consent considerations, so an enduring guardian appointment does not by itself settle organ donation.
Section 5: Signature, Date, and Witnessing
Sign and date the completed directive. While NSW law does not require witnessing for a common-law directive to be valid, having an independent witness sign strengthens enforceability if your directive is ever challenged. A GP, nurse practitioner, or solicitor all make strong witnesses because they can attest to your capacity at the time of signing.
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Common Mistakes That Undermine NSW Directives
The most frequent reason clinicians set aside a directive is vague language. Writing "I don't want to be kept alive by machines" does not tell the ICU team whether you refuse a ventilator for 48 hours to recover from pneumonia surgery or only refuse indefinite life-support. Another common error is failing to update the directive after a major health change — a directive written five years ago may not reflect your current clinical situation, and doctors may question whether your instructions still represent your informed wishes.
What to Do After Completing the Form
Upload a high-resolution PDF to your federal My Health Record so that any public hospital in Australia can retrieve it electronically. Give certified copies to your GP, your appointed enduring guardian, and any specialists who manage ongoing conditions. If you are entering residential aged care, hand a physical copy to the admissions team on your first day. NSW has no central registry for directives, so ensuring the people who need it can find it is entirely your responsibility.
For a complete system that pairs your advance care directive with the statutory enduring guardian form, clinical translation worksheets, and a post-death administrative timeline, see the NSW Advance Directive & Living Will Kit.
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