Advance care planning: lessons from a study of Tasmanian enduring guardianship forms

Michael A Ashby, Robert N Thornton and Robyn L Thomas
Med J Aust 2013; 198 (4): . || doi: 10.5694/mja12.10498
Published online: 4 March 2013

Uptake of available instruments is low, and death is the “elephant in the room”

There is an ongoing global conversation about death and the process of dying. Despite half a century of clinical, academic and public policy activity by specialist palliative care workers — and by many others, including health administrators, academics, artists and writers — it is common to hear the same issues recycled with the oft-repeated comment that we “do not do this well”. Clinicians struggle with treatment abatement decisions and issues relating to causes of and responsibility for death. Pathways to death (“death ways”) are changing, with increasing numbers of people dying in old age, slowly over 1–2 years, with multiple comorbidities (which often include dementia) and greater numbers of significant medical decision points.

  • 1 Royal Hobart Hospital, Hobart, TAS.
  • 2 School of Medicine and Menzies Research Institute, University of Tasmania, Hobart, TAS.
  • 3 Southern Fleurieu Health Service, Victor Harbor, SA.


The study on which this article is based was commissioned and funded by the Public Guardian at the Office of the Public Guardian (Tasmania) and access to the enduring guardianship forms was made possible by the President and staff of the Guardianship and Administration Board (Tasmania).

Competing interests:

No relevant disclosures.


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