10 Enduring powers – seatbelts of advanced care planning

<h3>Aim</h3> This presentation aims to highlight the importance of including Enduring Powers of Attorney and Guardianship in Advanced Care Planning. Professionals can only provide fully informed guidance to patients and families if they completely understand the complementary nature and function of Enduring Powers. <h3>Context</h3> During my 10 years working at the Western Australian agency of ‘last resort’ decision making, people regularly advised me that they had not heard of Enduring Powers before finding themselves caught in the system. Covering a remote region, I saw firsthand how the lack of awareness of these documents lead to increasing numbers of people, particularly of indigenous descent, finding themselves under the control of the metro-based government agency. This felt wrong. <h3>Narrative</h3> When I visited clients in the Pilbara, annually, I conducted community education sessions. Local professionals regularly expressed frustration that this service was not a regular fixture. Those who know of Enduring Powers (a surprising amount do not), are sometimes unsure how to approach the topic with patients and their families. The misconceptions and lack of clarity that exists around the ‘what, why and how’ of the documents contributes to the uncertainties. This needs to change. Wills are well known, but only relevant on our passing. Advanced Health Directives are prioritised when a major medical decision is anticipated, but these documents don’t give legal authority to the person you want to speak for you. Enduring powers do, and those who don’t have them are at increased risk of ending up under the control of a Public Guardian and Trustee. <h3>Unique Contribution</h3> My experience in the world of ‘last resort’ substitute decision-making can be a wake-up call. Enduring Powers are documents that, for many, are something akin to the colloquial ‘round tuit’: everyone should have them, but many don’t think they’re a priority and don’t get ‘around to it’ before it’s too late. Given the void of awareness and the need to encourage the conversations in advance, my insights into the ‘what, why and how’ will stimulate discussion, and give real life examples of the intrinsic perils of unpreparedness. <h3>Implications</h3> So, what does this have to do with Advanced Care planning? Everything. Just as seat-belts are recommended ‘just in case’, everyone should be prepared for the unexpected with Enduring Powers. In my experience, Advanced Care planning doesn’t always go beyond Advanced Health Directives and Wills. The inclusion of Enduring Powers needs to become standard practice.