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Re-thinking Advanced Health Care Directives


In her recently published Quarterly Essay, “Dear Life – On caring for the Elderly” doctor and writer Karen Hitchcock writes in a moving, compelling and at times controversial way about the manner in which we treat and deal with the elderly, including:

“The elderly, the frail are our society. They are our parents and grandparents, our carers and neighbours, and they are every one of us in the not-too distant future…They are not a growing cost to be managed or a burden to be shifted or a horror to be hidden away, but people whose needs require us to change”.

We elders have learned and their particular needs. a thing or two, including invisibility…Yes we’re invisible. Honoured, respected, even loved, but not quite worth listening to anymore

The article provides a timely wakeup call to all of us. Whether that is because we have aging parents or grandparents; or because we work in the aged care space; or whether we are just growing old ourselves. The fact that there is a moral dimension to aged care seems to have been forgotten in the desire to resolve the concerns – so often stated by politicians and journalists, about the increasing financial “burden” of caring for the aged.

In her essay, Doctor Hitchcock includes a quote from Roger Ansell, aged 93. “We elders have learned a thing or two, including invisibility…Yes we’re invisible. Honoured, respected, even loved, but not quite worth listening to anymore.” As a consequence of the manner in which we treat the aged, it is hardly surprising that many of them perceive themselves as being a burden or a nuisance. They apologise for being a pain and a drain on resources.

Viewed against this background, the increasing and almost invariable use of Advanced Health Care Directives for the elderly requires serious examination and re-thinking. They are promoted as supporting the elderly to control their health care and to enhance patient autonomy. However, there are real questions as to who really benefits from such directives. In many cases it will not be for the benefit of the elderly patient but for those charged with their care, whether that be the family, the aged care facility or those providing medical treatment. That is not to say that Advanced Health Care Directives do not have a place, where people have a strong and sustained wish to avoid particular treatments. However, requiring the whole aged population to have such documents in place cannot be in their best interests.

Elder law is a growing area of the law that will affect us all in our old age and is now seen by many as a discrete and specialised area of the law. It covers a multitude of legal issues,including:

• making a will;
• appointing an Attorney;
• making an Advanced Health CareDirective;
• choosing a retirement village;
• “granny flat” arrangements; and
• a range of matters constituting elderabuse.

DDCS Lawyers provides specialist advice and legal services in this expanding area of law. When providing advice and services, we are mindful of the social context of our clients We elders have learned and their particular needs.

Phillip Davey is a Partner of the firm.
18 Kendall Lane, New Acton, Canberra
phone (02) 6212 7600
[email protected],

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