Medical science has advanced in leaps and bounds in recent times.  Today medical science is able to prolong life whatever the condition of the patient, sometimes for very long periods of time.

The medical profession has the Hippocratic Oath which effectively means that doctors are bound to keep a patient alive through artificial life support systems and extraordinary medical measures, whatever the wishes of the patient or the likely long-term outcome to the patient.

The patient should have the choice to live or to pass away with dignity, particularly when there is no reasonable prospect of the patient ever again enjoying a reasonable quality of life, often at the considerable expense of the quality of life of those loved ones who are near and dear to the patient.

Euthanasia is illegal in Western Australia and this complicates the issue.

There is presently a bill before Parliament to introduce a new act, the Acts Amendment (Advance Health Care Planning) Bill 2006 ("Bill"), which, if passed in due course, will authorise the making of an Advanced Health Directive which will enable people to give (advance) directions to their medical management team and others in the unfortunate situation of them being unable to give instructions regarding their personal health and treatment themselves.

In the meantime, and until such time as the Bill becomes law (if it does), patients in such situations with no reasonable future expectation of a decent quality of life, their carers and their families have no way of resolving the impasse created by the Hippocratic Oath and the law.

In order to assist the medical profession, carers and loved ones it is possible to prepare Advance Medical Directives which set out the makers' intentions in relation to their future treatment in the event that they are unable to express those wishes at that time themselves.

The Advance Medical Directive is a very persuasive direction, in writing, as to what the maker wishes his/her appointee, family and the medical profession/carers to do in the event that he/she is unable to give that direction himself/herself.  

While it is legally unenforceable, until the Bill becomes law (if it does), the Directive does give a clear indication of the maker’s wishes to those who will need to make decisions for him/her regarding the nature and extent of treatment the maker desires (or does not desire, as the case may be).

For those who are involved in long-term patient care and where there is no reasonable prospect of any quality of life, the Advance Medical Directive is a most useful instruction and often relieves family members of the significant burden of decision-making at a very difficult time.

The preparation of an Advance Medical Directive at a time that the maker is of full mental capacity and with the full capacity competently to give instructions for the making of the Directive has been found to be of great benefit to loved ones and members of the medical profession, who can take comfort in knowing what the maker wants done at a time he/she cannot express those wishes.

The Advance Medical Directive is only one of the matters which need to be considered when giving attention to what might happen in the future.