Advance Care Directive Support Person Victoria

A Role Most People Don't Know Exists

Victoria's Medical Treatment Planning and Decisions Act 2016 created three distinct roles in advance care planning: the person making the Advance Care Directive, the Medical Treatment Decision Maker (MTDM), and the Support Person. Most Victorians have heard of the first two. Very few know the third exists, and fewer still use it — which is a missed opportunity, because the Support Person fills a gap that neither the directive nor the MTDM covers.

What a Support Person Does

A Support Person is someone you formally appoint to help you when you still have decision-making capacity but need assistance exercising it. Their job is to support you in understanding treatment options, communicating your preferences to clinical teams, and making decisions — not to make decisions for you.

This is fundamentally different from an MTDM. Your MTDM steps in only when you've lost capacity. A Support Person operates while you still have it but are struggling to exercise it effectively — perhaps because of fatigue, pain, medication side effects, cognitive impairment that hasn't yet reached the threshold of incapacity, or simply the overwhelming stress of being in a hospital.

In practical terms, a Support Person might:

• Attend medical appointments with you and help you process the information
• Remind you of treatment preferences you've previously expressed
• Help you communicate with clinical staff when you're finding it difficult
• Take notes during consultations so you can review them later
• Advocate for your stated preferences if clinical staff aren't listening

What a Support Person Cannot Do

The boundaries are clear and important:

• A Support Person cannot make decisions on your behalf. If you have capacity, the decision is yours. The Support Person helps you make it — they don't make it for you.
• A Support Person cannot override your decisions. Even if they disagree with what you're choosing, they have no authority to intervene.
• A Support Person has no authority once you lose capacity. At that point, your MTDM (or the statutory hierarchy) takes over. The Support Person's role ends.
• A Support Person cannot consent to or refuse treatment. Only you (while you have capacity) or your MTDM (after you've lost it) can do that.

Who Should Be Your Support Person

The best candidate is someone who knows your values and treatment preferences well, remains calm under medical pressure, and is comfortable speaking up in clinical settings. That could be a spouse, an adult child, a close friend, or a trusted community member.

It doesn't have to be the same person as your MTDM, and in some cases there are good reasons to appoint different people. Your MTDM handles the high-stakes, post-capacity decisions. Your Support Person handles the day-to-day navigation of healthcare interactions while you're still in the driver's seat.

Common pairings:

• Spouse as MTDM, adult child as Support Person. The adult child handles the medical appointments and information processing; the spouse steps in for the big decisions if capacity is lost.
• Adult child as both. If one person is your primary support in all healthcare contexts, they can hold both roles.
• Friend as Support Person, family member as MTDM. If your closest family is interstate or overseas, a local friend can attend appointments and advocate in person.

How to Appoint a Support Person

The appointment is made on a statutory form available from the Victorian Department of Health. It's a simpler process than appointing an MTDM:

• The form must be signed by you and the person you're appointing.
• Witnessing requirements are less onerous than for the ACD itself — check the current statutory form for the specific witnessing provisions, as they differ from the ACD's registered-medical-practitioner requirement.
• The appointee must consent to the role.

Once appointed, give copies of the appointment form to your GP, your treating hospital, and your MTDM. As with all advance care planning documents in Victoria, there is no central registry — distribution is your responsibility.

When the Support Person Role Matters Most

The role is most valuable during the grey zone of declining capacity — the period when a person with early-stage dementia, a progressive neurological condition, or age-related cognitive decline can still understand their treatment options but struggles to process complex medical information or articulate their preferences clearly.

During this period, a Support Person can ensure that the patient's voice is heard in clinical discussions, that treatment decisions reflect their values, and that the treating team doesn't default to making decisions for a patient who technically still has the legal right to make them.

The Victoria Advance Directive & Living Will Kit covers the Support Person appointment alongside the MTDM and ACD, with guidance on how the three roles work together and a conversation framework for discussing expectations with each appointee.

See more Victoria guides →