Your Emergency Plan

Put an Advance Directive in place before you become unwell.

Everyone has the right to make choices about their future health care. An advance directive says what treatment is acceptable before it is needed. It spells out what treatment a person agrees to, and what treatment they do not consent to receive if they become unwell in the future.

An advance directive only applies when a person is not competent to make all the decisions that are needed about their health care. When the person is competent again, an advance directive does not apply, because they can make their own decisions.

All competent people have the right to make an advance directive - and most people with mental illness are competent.

To make an advance directive, people must:

• be competent to make health treatment decisions
• have enough information to decide about their treatment
• make decisions of their own free will.

What are advanced directives?

An Advance Directive is about giving or refusing consent to treatment in the future. It is a statement to others, usually in writing setting out your treatment preferences if you experience another episode of mental illness that leaves you unable to decide or communicate your preferences at the time.

Under the New Zealand Code, advanced directives relate only to the type of health care and treatment you want. In some countries advance directives can include decisions not directly related to your health care, but in New Zealand different processes are needed to make theses wishes known.

What do I do to get one?

Discuss with family/ whānau

We suggest that people discuss their plans with family/whānau so they understand what treatment is wanted, and why. If a person wants someone to have a specific role in their treatment, they should talk to them first to get their agreement.

Write it down

An advance directive is more likely to be followed if it written down, so that doctors who are involved in a consumer's treatment can read it and know what treatment was agreed to and what treatment was refused.

Get it signed

We recommend that people discuss their treatment choices with their doctor, and ask him or her to sign the advance directive to confirm that they are:

• competent, and
• free from undue influence, and
• sufficiently informed about the treatment choices they are making.

This will increase the chance that the people caring for a service user will follow the directive. If a doctor or other professional does not sign to say the person is competent, then other doctors and nurses won't know if they should follow it later on, because they won't know if the person was competent when it was written.

Right 7(2) of the Health and Disability Code states:
"Every consumer must be presumed competent to make an informed choice and give informed consent, unless there are reasonable grounds for believing that the consumer is not competent."

We recommend that people get a doctor to confirm that they are competent by signing their advance directives. A doctor does not have to agree with the choices that are made to sign an advance directive. A signature simply confirms that the service user was competent at the time the advance directive was made.

Who needs one? (When to make one)

People are advised to make advance directives when they are well, so there is no doubt about their competence. If an advance directive is given when a person is very unwell, their competence to make the directive is more likely to be challenged, and the advance directive may not be followed.

Your family and advance directives

For families, there is nothing to fear in advance directives, because they are a useful tool for recovery. Families and friends may be involved in developing an advance directive, if they are asked by a service user. A service user, like anyone else, does not have to tell his or her family about their advance directive. However, many do involve their families and, in most cases, advance directives work well for families.

Families may feel they are in a difficult position if they find out when treatment they disagree with is being provided. Health providers may also feel they are put in a difficult position if this occurs. For this reason, the Mental Health Commission advises service users to talk about their ideas with family, whanau and friends, when developing an advance directive.

How to make an Advance Directive

You can make an advance directive by completing the FORM for an Advance Directive on this website. You don't need a lawyer to make an advance directive.

A valid advance directive

To be valid, an advance directive depends on:

• competence - whether the person was competent to make the directive when they made it; and
• freedom from undue influence - whether the person who made the directive was free from undue influence; and
• sufficient information - whether the person had sufficient information to make the particular directive they made; and
• application to current circumstances - whether the person intended their directive to apply to the present circumstances.
• If an advance directive meets all these criteria, it is valid, even if clinicians or family disagree with the choices it makes.

Ending an advance directive

An advance directive is valid until:

• the person changes it; or
• the person cancels it; or
• it expires and is not renewed (you can include an expiry date in your advance directive)
• because circumstances can change, an advance directive should be reviewed at least once a year.

Legal status of advance directives

Advance directives are allowed in New Zealand under common law. This means that while there is no law that specifically allows advance directives, people have always had the right to make choices about the treatment they receive. The Health and Disability Code supports that right. Advance directives have not yet been tested in New Zealand courts.

More Information

The Mental Health Commission and the Health and Disability Commission have a pamphlet 'Advance directives in mental health care and treatment: Information for mental health service users'. To obtain a copy you can download the document by clicking here or go to www.hdc.govt.nz, or you can get a copy from the Mental Health Commission.

The Health and Disability Commission has information about the Health and Disability Code of Rights, which applies to all health services.

If you think you require more protection than what an advance directive will achieve. An Enduring power of Attorney and crisis plan will protect your wishes and interests even more. Visit your lawyer to decide what course of actions will be best for you.