Advance Care Directives and Enduring Guardianship: What Families Should Know

By Care Steps Australia | Last updated: 25 October 2026

This article is general information, not legal advice. For advice about your situation, speak with a solicitor or NSW Trustee and Guardian.

An Advance Care Directive records your own wishes about future medical treatment. An Enduring Guardian is a person you appoint to make health, lifestyle and accommodation decisions when you can't. In NSW you can have both. NSW Health says a directive is legally binding, and both documents must be made while you still have decision-making capacity.

Key Takeaways

• An Advance Care Directive is about your wishes. An Enduring Guardian is about a person.
• Both only come into effect when you can no longer make or communicate your own decisions.
• Both must be made while you have decision-making capacity, so families should not wait for a crisis.
• An Enduring Guardian cannot make decisions about money. That is the role of an enduring power of attorney.
• If there is no Enduring Guardian, NSW law sets an order for who can consent to treatment, called the "person responsible".

What Is the Difference Between an Advance Care Directive and Enduring Guardianship?

An Advance Care Directive tells your doctors what treatment you would want or refuse. An Appointment of Enduring Guardian names someone to decide for you. The Local Court of NSW states plainly that they are not the same thing, though they can be related. Many families make both, so the guardian has clear written wishes to follow.

Which Document Does What? ACD, Enduring Guardian, Power of Attorney and Advance Care Plan

Families often mix these four documents up. Each covers a different part of life.

A power of attorney cannot consent to medical or dental treatment, according to NSW Health. In NSW, an attorney can only make financial and legal decisions.

What an Advance Care Directive Covers in NSW

An Advance Care Directive sets out the care and treatment you would want if you were seriously ill or injured and unable to speak for yourself. NSW Health's advance care planning guidance explains the key rules:

• It can be spoken or written, and you must have decision-making capacity to make it.
• Nobody can make one for you, although someone can help you write it down.
• It should include clear and specific details about treatments you would accept or refuse.
• It only takes effect when you can't make or communicate decisions. While you can speak for yourself, your current wishes take priority.
• It cannot be used to request voluntary assisted dying.

NSW Health recommends reading it once a year, keeping it somewhere easy to find, leaving copies with your person responsible, family or carer, doctor or healthcare facility, and uploading it to My Health Record.

What an Enduring Guardian Can and Can't Decide

An Enduring Guardian only makes decisions in the areas you choose when you appoint them.

The Local Court of NSW adds two limits families should know: a guardian can only consent to treatment that will promote or maintain your health and wellbeing, and cannot consent to treatment you object to.

Who Can and Can't Be an Enduring Guardian

Choose someone you trust, who understands your values and is easy to contact when decisions need to be made. The person must be over 18. The NSW Government says the role is unpaid and that you cannot appoint:

• someone who, for a fee or reward, is professionally responsible for providing you with medical services, accommodation or daily living support
• the Public Guardian or NSW Trustee and Guardian.

A family member who is your carer and receives the Centrelink carer payment can still be appointed. You can also appoint more than one guardian, to act together (jointly), separately (severally) or both, and you can name a substitute guardian who steps in if your first choice can't.

How to Appoint an Enduring Guardian in NSW: Step by Step

1. Decide who and what. Choose your guardian, any alternate or substitute, and the decision areas they will cover.
2. Talk to them first. Make sure they are willing and understand your wishes.
3. Get the document prepared. NSW Trustee and Guardian prepares Appointment of Enduring Guardian documents as part of its service and does not hand out blank forms. You can also use a solicitor, or obtain the form from a post office or a Local Court registry.
4. Sign in front of an eligible witness. In NSW this is an Australian legal practitioner, a Local Court registrar (by appointment), an overseas-registered foreign lawyer, or an approved employee of NSW Trustee and Guardian or the Office of the Public Guardian. The witness explains the effect of the appointment and certifies that you appear to understand it.
5. Your guardian accepts. The person you appoint signs to accept, and that signature is also witnessed.
6. Store and share it. Registration is not required, although you can register it in the General Register of Deeds for safekeeping for a fee.

See the NSW Government's guide to choosing an enduring guardian for the full rules.

How to Make an Advance Care Directive: Step by Step

NSW Health recommends this process:

1. Understand the health and ageing issues you may face.
2. Think about your values and wishes for care and treatment.
3. Discuss them with your family, friends and treating team.
4. Identify your person responsible or Enduring Guardian.
5. Complete an Advance Care Directive using the NSW Health form and information booklet.

Speak with your GP or treating team while you write it, so the medical details are relevant. For questions about advance care planning, the National Advance Care Planning Support Service is on 1300 208 582.

What Happens If There Is No Enduring Guardian?

Under the Guardianship Act 1987, healthcare decisions fall to the "person responsible", in this order:

1. A guardian or enduring guardian with the right to consent to medical and dental treatment.
2. A spouse, de facto spouse or partner in a close continuing relationship.
3. An unpaid carer who regularly provides or arranges domestic support.
4. A relative or friend with a close personal relationship, frequent contact and personal interest in the person's welfare.

If decisions are needed about areas such as accommodation and nobody has authority, a court or tribunal may need to appoint a guardian under a Guardianship Order through the Guardianship Division of NCAT.

Why Timing Matters: Capacity, Dementia and Acting Early

Both documents need decision-making capacity at the time they are made. Capacity can be lost suddenly through illness or injury, or gradually through conditions such as dementia. Once it is gone, a person can no longer make an Advance Care Directive or appoint an Enduring Guardian. Families can still complete an Advance Care Plan with or for the person, but it is not legally binding. Our guide to dementia care at home in Sydney covers what families face as needs change.

How to Start the Conversation as a Family

1. Pick a calm time, not a hospital visit.
2. Ask about values first: what matters most, what a good day looks like, what they fear.
3. Ask who they would trust to decide for them.
4. Write down what they say, then move on to the formal documents.
5. Agree who keeps the copies and who tells the GP.

Support in Your Language

NSW Trustee and Guardian publishes its Enduring Guardianship factsheet in Arabic, Chinese Simplified, Chinese Traditional, Greek, Spanish and Vietnamese, on its publications and policies page. For families in Punchbowl, Bankstown and Lakemba, that can make the first conversation easier. Our article on culturally appropriate aged care for multicultural families has more on care that respects language and culture.

Family Checklist: What to Do This Month

1. Talk with your parent or partner about their values and wishes.
2. Book their GP to discuss an Advance Care Directive.
3. Download the NSW Health form and information booklet.
4. Choose an Enduring Guardian and a substitute.
5. Book NSW Trustee and Guardian or a solicitor to prepare the appointment.
6. Arrange an eligible witness for both signatures.
7. Consider an enduring power of attorney for financial decisions.
8. Upload the directive to My Health Record.
9. Give copies to the guardian, the GP and the care provider.
10. Diarise a yearly review.

How Care Steps Supports Families After the Paperwork

Planning documents set out who decides and what someone wants. Day-to-day care is a separate question. Care Steps Australia is a registered NDIS provider based in Punchbowl, with a clinically led team, providing aged care and Support at Home services for older people living at home. If you are in Bankstown or Yagoona, see our aged care services in Bankstown for in-home respite, personal care and nursing. Share a copy of your parent's directive with whoever provides their care, so everyone works from the same wishes.

Talk to Care Steps Australia

If your family is planning care for an older parent, contact us to talk through support at home.

Care Steps Australia 48 Lancaster Avenue, Punchbowl NSW 2196 Phone: (02) 8201 3100 Email: info@carestepsaustralia.com.au Find us on Google Maps: https://maps.app.goo.gl/ZsJQgwvKcMMUVb1MA

In Short

An Advance Care Directive records what you want. An Enduring Guardian is the person who decides when you can't. In NSW, both must be made while you have capacity, a directive is legally binding, and a guardian cannot decide about money. Start the conversation early, use the NSW Health form and NSW Trustee and Guardian, and share copies with your GP and care provider. For support at home in Punchbowl and Bankstown, call Care Steps Australia on (02) 8201 3100.

Sources checked 25 October 2026: NSW Health, Advance Care Planning; NSW Government and NSW Trustee and Guardian, Choose an enduring guardian, Choose a Power of Attorney and fees; Local Court of NSW, Power of Attorney and Enduring Guardianship.