Dr Sonia Fullerton
Planning for the future: ADVANCE CARE PLANNING
A fter a breast cancer diagnosis, some people feel like they lose a sense of control over their bodies and lives, even when they have been actively involved in making decisions about their treatment. Imagine, then, not being consulted about your own medical treatment. This could happen if you become suddenly unwell or are involved in an accident. Would your loved ones know what you wanted? This is an issue Dr Sonia Fullerton experiences on a daily basis as a physician in palliative care medicine and as the Deputy Chief Medical Officer at the Peter MacCallum Cancer Centre in Melbourne. She’s a firm advocate for everyone preparing an advance care plan so they maintain control over the medical treatment they receive if they lose capacity. ‘ Having an advance care plan means that even if you’re very unwell and can’t verbalise your wishes, you will still be heard,’ Sonia says. ‘It’s not like a will, which is a plan for what happens after you die. An advance care plan is about what happens to you while you are still alive. It ensures doctors can make treatment decisions in line with your preferences.’ While the terminology and process can vary from state to state, there are two main components to advance care planning: 1. C hoosing a substitute decision maker who can make medical treatment decisions on your behalf.
2. O utlining the decisions you want that person to make. This may include writing down your values and preferences, or whether you consent to certain treatments or medical interventions. Your decision maker can only act on your behalf when you lose capacity. Your capacity will be assessed at the time by a medical practitioner. Once you have made a plan, make sure people know about it by: • u ploading your plan to your My Health Record • g iving a copy to your substitute decision maker, your GP, and any other health services involved in your care • carrying an image of the document on your phone or a copy in your bag, especially if you are travelling interstate. If someone doesn’t have a medical decision maker, a medical team will generally go through a list to work out who to ask for consent, including the person’s partner or spouse, and then adult children and other relatives. ‘Anyone at risk of losing their medical treatment decision making capacity should consider advance care planning. It’s particularly relevant for people who are older, or for people who have life-limiting conditions such as cancer, especially metastatic disease, or who have had a notable change in their health,’ says Sonia. ‘And, remember, you don’t have to wait for your doctor to bring up an advance care plan with you—you can raise it with them anytime .’
For more information, including advice specific for each state or territory, visit the Advance Care Planning Australia website .
CHOOSING YOUR SUBSTITUTE DECISION MAKER Your decision maker doesn’t have to be a family member, but whoever you choose needs to be someone: • you have a close and continuing relationship with • who knows your wishes and understands they need to represent them • who is able to make decisions, understand medical information and confidently negotiate or advocate on your behalf. Generally, you don’t need to appoint someone if you’re married or in a de facto relationship and your partner is the person you would choose to appoint. If you identify as LGBTIQ+, an advance care plan can reinforce your partner’s role in your life and ensure their rights in your end-of-life
decision making are recognised.
Listen to BCNA’s Upfront about Breast Cancer podcast episode with Sonia to hear more about advance care planning or read more in My Journey .
December 2022 | Issue 93
Breast Cancer Network Australia
12
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