Advance Care Planning: A 5-Country Legal Guide
Living abroad or moving countries? Our expert guide compares advance care planning laws across major English-speaking countries to help you create a valid plan no matter where you reside.
Advance Care Planning: A 5-Country Legal Guide
December 14, 2025
Advance care planning allows individuals to document their healthcare preferences for situations where they cannot communicate. However, the legal frameworks, terminology, and processes vary significantly between countries. As an expert in this field, I'll guide you through the key differences and similarities in advance care planning across the United States, United Kingdom, Canada, Australia, and New Zealand.
Why International Understanding Matters
Understanding international differences in advance care planning is increasingly important in our mobile world:
- People frequently relocate between countries for work and retirement
- Many families have members across multiple countries
- Medical emergencies can occur while traveling
- Healthcare providers encounter directives from various jurisdictions
- Digital records may need to work across borders
- Cross-border recognition of directives varies significantly
"As our lives become more international, understanding how advance care directives work across borders becomes essential," explains advance care planning experts.
Key Elements of Advance Care Planning Systems
While each country has unique approaches, several core elements exist across jurisdictions:
1. Advance Directives / Living Wills
Documents outlining treatment preferences:
United States:
- Called Advance Directives or Living Wills
- State-specific statutory forms
- Generally requires two witnesses or notarization
- Focus on end-of-life and life-sustaining treatment decisions
- Some states have registries for storage
United Kingdom:
- Called Advance Decisions to Refuse Treatment (ADRT)
- Must be in writing if refusing life-sustaining treatment
- Requires signature, dating, and witness
- Must include statement that it applies even if life is at risk
- No central registry system
Canada:
- Terminology varies by province/territory (Advance Directive, Personal Directive, Healthcare Directive)
- Provincial/territorial legislation governs requirements
- Generally requires witnessing (one or two witnesses)
- Some provinces have registries
- Quebec has distinct civil law approach
Australia:
- Called Advance Care Directives
- Each state/territory has different forms and requirements
- Some jurisdictions have registries
- Witnessing requirements vary by state
- Integration with My Health Record
New Zealand:
- Called Advance Directives
- Common law recognition without specific statutory forms
- Should be in writing and witnessed
- Code of Health and Disability Services Consumers' Rights provides framework
- No central registry
"The terminology and legal requirements for written directives vary substantially between countries, making jurisdiction-specific knowledge essential," advises online will writing.
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2. Healthcare Proxy / Agent Appointment
Designating someone to make decisions when you cannot:
United States:
- Called Healthcare Proxy, Medical Power of Attorney, or Healthcare Agent
- State-specific forms and requirements
- Usually integrated with or complementary to advance directives
- Generally requires two witnesses or notarization
- Some states have restrictions on who can serve as agent
United Kingdom:
- Called Lasting Power of Attorney for Health and Welfare
- Must be registered with the Office of the Public Guardian
- Requires certificate provider confirming understanding
- Must specifically grant authority for life-sustaining treatment decisions
- Different systems in England/Wales, Scotland, and Northern Ireland
Canada:
- Terminology varies by province (Substitute Decision Maker, Healthcare Representative, Agent, Proxy)
- Provincial/territorial legislation determines requirements
- Many provinces have statutory hierarchy of default decision-makers
- Some provinces separate healthcare and financial powers
- Quebec uses mandates and civil law approach
Australia:
- Terminology varies by state (Medical Treatment Decision Maker, Enduring Guardian, Healthcare Agent)
- Each state/territory has different forms and requirements
- Some jurisdictions integrate with advance care directives
- Generally requires witnessing
- Some states have public guardian systems
New Zealand:
- Called Enduring Power of Attorney for Personal Care and Welfare
- Must be completed while person has capacity
- Takes effect only when person loses capacity
- Cannot consent to some specific treatments
- Must be witnessed by lawyer, qualified legal executive or authorized officer
"The legal authority granted to healthcare decision-makers varies significantly between countries, affecting both documentation and implementation," notes experts in healthcare decision maker roles.
3. Physician Orders for Life-Sustaining Treatment
Medical orders for those with serious illness:
United States:
- POLST (Physician Orders for Life-Sustaining Treatment) or MOLST (Medical Orders)
- Brightly colored forms that stay with patient
- Signed by both patient (or representative) and physician
- Recognized across care settings
- Implementation varies by state
United Kingdom:
- ReSPECT (Recommended Summary Plan for Emergency Care and Treatment)
- Some regions use TEP (Treatment Escalation Plan)
- Focus on emergency care and treatment recommendations
- Completed through conversations with healthcare professionals
- Not nationally standardized
Canada:
- Various provincial approaches (Goals of Care Designations in Alberta, Medical Orders for Scope of Treatment in BC)
- Generally physician-completed orders
- Focus on current medical condition rather than future scenarios
- Not uniformly implemented across all provinces/territories
- Some jurisdictions use color-coded systems
Australia:
- Resuscitation Plans or Goals of Care forms
- State-based systems rather than national
- Completed by medical practitioners
- Focus on current medical condition
- Some states have specific statutory frameworks
New Zealand:
- Resuscitation Care Plans
- Not standardized nationally
- Typically hospital or provider-specific
- Focus on immediate treatment decisions
- Requires clinical judgment about appropriate interventions
"These physician-completed orders bridge advance directives and immediate clinical care for those with serious illness," explains advance health directive specialists.
Legal Frameworks Governing Advance Care Planning
The legal foundation for advance care planning varies substantially between countries:
United States
- State-based legislation with 50 different systems
- Patient Self-Determination Act (federal) requires healthcare facilities to inform about advance directives
- Some federal rules for specific settings (e.g., Medicare, VA facilities)
- Mix of statute and case law varies by state
- Some interstate recognition but inconsistent
"The US system creates a patchwork of state requirements with limited federal standardization," advises specialists in online advance directive form.
United Kingdom
- Mental Capacity Act 2005 (England and Wales)
- Adults with Incapacity (Scotland) Act 2000
- Mental Capacity Act (Northern Ireland) 2016
- Common law recognition of advance decisions
- Capacity determination framework legally defined
- No specific advance directive legislation in some regions
"UK systems center on capacity legislation rather than specific advance directive statutes in most regions," explains experts in healthcare directives online.
Canada
- Provincial/territorial jurisdiction over healthcare
- No federal legislation specifically addressing advance care planning
- Quebec Civil Code differs from common law provinces
- Health Care Consent Act in some provinces
- Substitute Decisions Act in some jurisdictions
- Recognition varies between provinces
"Canada's provincial/territorial approach creates distinct systems across the country with limited cross-border recognition," notes family legacy planning.
Australia
- State/territory-based legislation
- Different statutory frameworks in each jurisdiction
- Some states with specific advance care directive legislation
- Others rely on guardianship legislation
- Common law recognition in some contexts
- Limited mutual recognition between states
"Australia's federated approach results in eight different legal frameworks for advance care planning," advises advance care planning.
New Zealand
- Code of Health and Disability Services Consumers' Rights
- Protection of Personal and Property Rights Act 1988
- Common law recognition of advance directives
- No specific legislation for advance directives
- Right 7(5) of the Code provides right to use advance directives
- Health and Disability Commissioner oversight
"New Zealand's system relies more on rights-based frameworks and common law than specific advance directive legislation," explains specialists in record medical wishes.
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Cultural and Healthcare System Context
Beyond legal differences, important cultural and healthcare system factors influence advance care planning:
United States
- Strong emphasis on individual autonomy
- Litigation concerns influence implementation
- Privatized healthcare creates access disparities
- Religious and cultural diversity affects utilization
- State-by-state variations in default decision-maker hierarchies
- Significant advocacy for advance care planning
"The US approach strongly emphasizes individual choice and written documentation within a complex healthcare system," notes online will writing.
United Kingdom
- NHS provides universal healthcare context
- More emphasis on clinical judgment alongside directives
- General practitioner (GP) coordination role
- Growing focus on digital coordination of care plans
- Religious and cultural considerations in diverse population
- Regional variations in implementation and resources
"The UK system balances written directives with clinical judgment within the NHS universal healthcare context," advises experts in digital healthcare documentation.
Canada
- Universal healthcare through provincial/territorial systems
- Emphasis on substitute decision-makers over written directives in many regions
- Strong focus on consent and capacity determination
- Indigenous perspectives increasingly recognized
- French and English language considerations
- Provincial variations in resource allocation and support
"Canada's approach often emphasizes the role of substitute decision-makers within its universal healthcare framework," explains legacy preservation blog.
Australia
- Universal Medicare system with public and private providers
- Growing integration with My Health Record digital system
- Indigenous cultural considerations increasingly addressed
- Diverse multicultural population needs
- Aged care interface with advance care planning
- Rural and remote access considerations
"Australia's approach increasingly focuses on digital integration while addressing its geographically dispersed, culturally diverse population," notes dementia care activities specialists.
New Zealand
- Public healthcare system with universal coverage
- Treaty of Waitangi principles influence healthcare delivery
- Māori cultural perspectives on healthcare decisions
- Pacific Islander cultural considerations
- Growing emphasis on shared decision-making models
- Integrated care approaches
"New Zealand's system increasingly incorporates cultural perspectives, particularly Māori worldviews on healthcare and decision-making," advises experts in advance care directive.
Digital Infrastructure and Innovation
Digital approaches to advance care planning vary significantly between countries:
United States
- Electronic health record (EHR) integration varies by system
- Some state electronic registries
- Private advance directive registry services
- Growing telehealth advance care planning services
- Mobile apps for storage and emergency access
- Veterans Affairs digital system
"The US has substantial private sector innovation alongside fragmented institutional systems," explains specialists in digital healthcare planning.
United Kingdom
- NHS App integration developing
- Electronic Palliative Care Coordination Systems (EPaCCS)
- Coordinate My Care platform in London
- NHS Digital transformation initiatives
- Summary Care Record integration
- Regional variations in digital infrastructure
"The UK's NHS provides a unified framework for digital advance care planning, though implementation varies regionally," notes digital legacy vault specialists.
Canada
- Provincial electronic health record initiatives
- Some provincial digital health record systems
- Digital Health Immunization/COVID integration models
- Advance care planning apps and tools being developed
- Limited national coordination
- Provincial digital health strategies
"Canada's digital infrastructure for advance care planning remains primarily provincial with limited national coordination," advises experts in online healthcare planning.
Australia
- My Health Record national system
- Advance Care Planning in My Health Record
- State-based electronic medical record systems
- National repository for digital advance directives developing
- Australian Digital Health Agency initiatives
- Electronic persistent pain outcomes collaboration
"Australia's My Health Record provides a national framework for digital advance care planning integration," explains specialists in secure directives storage.
New Zealand
- Patient portals through primary care
- Health Information Platform development
- Growing emphasis on digital health technologies
- Regional shared care platforms
- Limited national advance care planning digital infrastructure
- Innovative local digital initiatives
"New Zealand is developing digital infrastructure with regional variation in advance care planning integration," notes experts in digital estate planning.
Best Practices for International Advance Care Planning
For those with international connections, consider these approaches:
1. Research and Documentation
- Research requirements for all relevant jurisdictions
- Create jurisdiction-specific documents for each country
- Include international contact information
- Consider video supplements explaining your values
- Document the reasoning behind your choices
- Keep all documents updated with current information
2. Communication and Access
- Inform healthcare providers in all relevant countries
- Provide copies to family members in each location
- Consider digital legacy vault services with international access
- Carry emergency information when traveling
- Create wallet cards in relevant languages
- Establish emergency contact protocols across countries
3. Professional Guidance
- Consult with healthcare providers in each country
- Seek legal advice specific to each jurisdiction
- Consider international estate planning expertise
- Work with cultural mediators if needed
- Use translation services for accurate documentation
- Verify requirements with relevant consulates or embassies
"International advance care planning requires jurisdiction-specific documentation and careful attention to cross-border issues," advises online will writing.
Future Developments and Trends
Looking ahead, several trends are emerging across countries:
Digital Integration and Accessibility
- Growing electronic health record integration
- Mobile applications for emergency access
- Blockchain verification of directive authenticity
- International standards development
- Artificial intelligence for directive interpretation
- Telehealth advance care planning services
"Digital solutions increasingly address the challenges of accessibility and verification across borders," explains specialists in online ACP.
Legal Harmonization Efforts
- Developing international recognition frameworks
- Standardized format initiatives
- Regional reciprocity agreements
- International private law considerations
- Cross-border healthcare directives in certain regions
- Professional association guidelines for recognition
"Efforts to harmonize legal frameworks aim to improve cross-border recognition of advance directives," notes experts in advance care planning online.
Person-Centered Approaches
- Greater emphasis on values statements
- Video and multimedia supplements
- Culturally responsive frameworks
- Indigenous and traditional perspectives incorporation
- Narrative approaches to complement formal directives
- Supported decision-making models
"The future of advance care planning increasingly focuses on person-centered approaches that capture individual values across cultural contexts," recommends advance care planning.
Conclusion
Advance care planning systems reflect each country's unique legal traditions, healthcare systems, and cultural contexts. While the core goals remain consistent—documenting preferences and appointing trusted decision-makers—the specific processes, documents, and legal frameworks vary significantly between the United States, United Kingdom, Canada, Australia, and New Zealand.
For those with international connections, understanding these differences is crucial for creating effective advance care plans that will be respected across relevant jurisdictions. This may require creating multiple sets of documents, seeking jurisdiction-specific advice, and establishing clear communication systems with healthcare providers and loved ones in different locations.
Despite these challenges, the effort to create internationally effective advance care planning is worthwhile. By understanding the differences between systems and taking appropriate steps to address them, you can ensure your healthcare wishes will be respected regardless of where care is provided.
"As our world becomes increasingly connected, advance care planning must adapt to cross jurisdictional boundaries while respecting diverse legal and healthcare systems," emphasizes sign up for free with services that provide guidance for international advance care planning.
Planning your will isn’t just about assets — it’s about protecting people, values, and clarity for those you love. Alongside preparing your legal documents, explore advance care planning resources to ensure your healthcare wishes are understood, and find gentle guidance for dementia support when planning for long-term wellbeing. Reflect on what truly matters through family legacy preservation resources, and digitise your legacy with a digital legacy vault that your loved ones can trust.
When the time comes to discuss your decisions, explore nurse information and care advice, and see how advance health directive tools help formalise your choices. For those seeking remembrance, discover thoughtful online tribute options, and read about great digital family legacy tools that make it easy. Begin early, act clearly, and protect your family’s future — peace of mind starts with preparation.
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