Values Directive vs Instructional Directive Victoria: Which One Makes Your Wishes Binding

Two Types of Directive, Two Levels of Legal Force

Victoria's advance care directive can contain two fundamentally different types of content, and confusing them is one of the most common mistakes in end-of-life planning. An instructional directive is legally binding on health practitioners. A values directive guides your decision-maker but can be interpreted. Getting the wrong type for the wrong situation means your wishes may not carry the weight you intended.

What an Instructional Directive Does

An instructional directive is a specific, binding medical treatment order. Under the Medical Treatment Planning and Decisions Act 2016, when a health practitioner encounters a valid instructional directive in your ACD, they must follow it as if you were making the decision with full capacity in the room.

Instructional directives deal in concrete clinical interventions:

• "I refuse cardiopulmonary resuscitation."
• "I consent to a trial of mechanical ventilation for a maximum of 72 hours, after which I refuse continued ventilation if there is no clinically assessed prospect of independent breathing."
• "I refuse artificial hydration and nutrition if the treating medical practitioner determines I have a terminal condition with no reasonable prospect of recovery."
• "I consent to temporary life-sustaining treatment required solely to facilitate organ and tissue donation."

Notice the precision. Each instruction names a specific treatment, specifies a clear condition or timeframe, and uses language a clinician can act on immediately. That precision is what makes it binding — there's no room for interpretation.

Your Medical Treatment Decision Maker cannot override an instructional directive. Your family cannot override it. The clinical team cannot substitute their judgement. The instruction stands.

What a Values Directive Does

A values directive describes your priorities, beliefs, and what quality of life means to you. It doesn't give specific clinical orders — instead, it gives your MTDM the context to make decisions about situations your instructional directives don't cover.

Values directive content sounds different:

• "I value being able to recognise and hold conversations with my family above all other considerations."
• "I consider permanent dependence on others for basic personal care an unacceptable outcome."
• "My cultural and spiritual practices are central to my identity — I want my care to accommodate them wherever possible."
• "I would rather have a shorter life with full cognitive function than a longer life with severe impairment."

These statements are critically important for your MTDM, but they don't bind clinicians in the same way. A doctor reading your values directive should factor your priorities into clinical decision-making, and your MTDM should use them as the foundation for any decisions they make — but values directives are guidance, not commands.

Why You Need Both

Most effective ACDs include both types. Here's why:

Instructional directives can't cover every scenario. You can refuse CPR, ventilation, and artificial nutrition — but you can't anticipate every possible medical situation. When something unexpected arises, your MTDM needs to know your values to make a decision that aligns with who you are.

Values directives alone lack teeth. If you only write values statements ("I don't want to be kept alive artificially"), a clinician might interpret that differently from how you intended. Adding instructional directives that operationalise your values removes the interpretation gap for the most important decisions.

The combination creates a complete framework. Instructional directives handle the scenarios you can foresee. Values directives handle everything else. Together, they give both clinicians and your MTDM a clear picture of what you want and why.

How to Write an Instructional Directive That Works

The difference between a binding instruction and an unenforceable wish often comes down to wording:

Too vague to be binding: "No heroic measures." (What counts as heroic? Heroic to whom?)

Clear and binding: "I refuse cardiopulmonary resuscitation in all circumstances."

Too vague: "I don't want to be on life support." (Life support includes ventilation, dialysis, artificial nutrition, vasopressors — do you refuse all of them? In all circumstances?)

Clear and binding: "I refuse mechanical ventilation if the treating medical practitioner assesses that I have no reasonable prospect of independent breathing within 72 hours."

The key is using specific medical terminology, naming the treatment explicitly, and defining the conditions under which the instruction applies. Your GP can help translate personal preferences into clinical language during the drafting process.

How to Write a Values Directive That's Useful

Values directives should be specific enough that your MTDM can apply them to real decisions. Abstract statements like "I want dignity" don't help a decision-maker facing a concrete clinical choice at 2am.

Better approach: describe what dignity looks like to you in practical terms. What activities or abilities make life worth living? What outcomes would you find unacceptable? What matters more to you — length of life or quality of life? What role do cultural, spiritual, or religious practices play in your care?

Your MTDM will use these answers as a filter: "Would Mum accept this treatment, given what she told me matters?" The more concrete your values directive, the more confident your MTDM can be in their decisions.

Getting the Balance Right

The Victoria Advance Directive & Living Will Kit includes separate templates for instructional and values directives, with clinician-approved language for common treatment decisions and a values questionnaire designed to produce directive content that's genuinely useful to your MTDM.

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