What to Include in an Advance Care Directive South Australia

The Gap Between What People Write and What Actually Works

Most people who complete their Advance Care Directive in South Australia write something along the lines of "no heroic measures" or "let me go peacefully." These feel meaningful. They're sincere expressions of deeply held values.

They're also legally useless as binding provisions.

Under the Advance Care Directives Act 2013, the distinction between a binding provision and a non-binding value statement determines whether clinicians must follow your instructions or can set them aside. Understanding this distinction is the single most important thing you can do when filling out your ACD.

Binding Provisions vs Value Statements

A binding provision is a specific instruction — usually a refusal of medical treatment — that clinicians are legally required to follow when the relevant clinical circumstances arise. To be binding, the instruction must be clear enough that a healthcare team can act on it without interpretation.

A non-binding value statement is a broader preference, value, or wish that guides decision-making but doesn't compel specific clinical action. Clinicians should consider it. Your SDM should try to honour it. But in a crisis, if the instruction is too vague, the clinical team defaults to preserving life.

The test isn't about your intent — it's about precision. Here's how the same wish can be expressed both ways:

What Your ACD Can Include

The ACD form has several sections. Here's what goes where and what to think about:

Part 1: Your Values and Wishes (Non-Binding)

This section captures your general values, preferences, and the principles you want guiding decisions about your care. These are non-binding, but they're still important — they give your SDM and medical team context for situations your binding provisions don't cover.

Consider documenting:

• Quality of life boundaries — what conditions would make life unacceptable to you? Being unable to recognise family? Being unable to communicate? Being permanently dependent on others for all personal care?
• Living arrangements — do you want to stay at home as long as possible? Are there specific aged care facilities you prefer or want to avoid?
• Daily life preferences — religious observances, dietary requirements, social contact preferences, music, routines
• Care philosophy — do you prioritise comfort over longevity? Do you want all available treatments tried even if the odds are poor?

Part 2: Binding Refusals of Treatment

This is where clinical precision matters. For each treatment you refuse, specify:

• The exact treatment — name it: CPR, mechanical ventilation, intubation, dialysis, artificial nutrition via PEG tube, IV antibiotics, blood transfusion
• The clinical circumstances — when does this refusal apply? "If I have a terminal illness with less than 6 months life expectancy." "If I have suffered an irreversible brain injury." "If I am in a persistent vegetative state."
• What you want instead — palliative care, pain management, comfort measures. Be explicit that you consent to symptom relief even if it may hasten death.

A refusal without clinical context isn't much use. "I refuse dialysis" — always? Even for a temporary kidney injury after a car accident where full recovery is expected? Specify the circumstances.

Part 3: SDM Appointments

This is where you appoint your Substitute Decision-Makers. You can appoint up to four, in ranked order. For each SDM, consider:

• Their order of preference (first preferred, second, third, fourth)
• Any conditions or limitations on their authority
• Whether they can act jointly or severally (if you appoint more than one at the same level)

Part 4: Organ and Tissue Donation

You can express a preference about organ and tissue donation in your ACD. Note that this is a preference statement — the actual donation process is managed through the Australian Organ Donor Register and hospital protocols. Your family will still be consulted at the time, so discussing your preference with them beforehand matters.

What Your ACD Cannot Include

The Act sets clear boundaries:

• Financial instructions — no bank account management, property transactions, or investment decisions. These require an EPA.
• Requests for active euthanasia — the ACD cannot be used to request voluntary assisted dying. VAD operates under its own separate legislation with specific eligibility and request procedures.
• Demands for treatment — you can refuse treatments, but you cannot compel a doctor to provide a treatment they consider medically futile or non-beneficial.
• Instructions that require illegal action — nothing in the ACD can authorise conduct that would otherwise be unlawful.
• Post-death instructions — the ACD ceases at death. Funeral arrangements and estate matters need a will.

The Suicide Override You Should Know About

The 2024 amendments to the Act added one important exception to binding refusals. If a clinician reasonably suspects that a patient's life-threatening condition was caused by attempted suicide or self-harm, they can administer life-saving treatment despite a binding refusal in the patient's ACD.

This means a binding refusal of resuscitation won't prevent emergency treatment following a deliberate overdose or self-harm event. The override is narrow — it only applies when suicide or self-harm is reasonably suspected — but it's an important contextual limit on the binding refusal mechanism.

Getting the Language Right

The hardest part of writing an ACD isn't the paperwork. It's finding language that's specific enough to be binding without being so narrow that it misses the clinical scenario you actually face.

Working with your GP or a health professional when drafting the medical sections can help — they can translate your values into clinical terminology that hospital teams will recognise and act on.

Our South Australia Advance Directive & Living Will Kit includes a treatment decision worksheet with clinically precise drafting examples for the most common scenarios — end-stage terminal illness, acquired brain injury, dementia progression, and organ failure — so your wishes translate into enforceable instructions, not aspirational statements.

See more South Australia guides →