Advanced Care Planning NZ: Making Your Wishes Known
Advanced care planning is one of the most important things a person can do — and one of the most commonly put off. It's the process of thinking about, talking about, and writing down your wishes for future health care, so that the people around you know what matters to you if you can no longer tell them yourself.
In New Zealand, this is most often done through a document called an Advance Care Plan (ACP). It's not a legal document in the same way as an Enduring Power of Attorney, but it carries real weight. When completed well and shared with the right people, it can shape decisions made by doctors, nurses, family members, and care teams during some of the most difficult moments of a person's life.
This guide explains what advanced care planning involves, how to do it, what documents you might need, and how to start the conversation with the people who matter.
What Is Advanced Care Planning?
Advanced care planning is a process, not a single document. It involves:
Reflecting on what matters most to you — your values, beliefs, and what makes life meaningful
Thinking about the kind of care you would or wouldn't want in different situations
Talking with your family, friends, and health care team about your wishes
Writing those wishes down, ideally in a recognised format
Reviewing and updating your plan as your situation or thinking changes
It's sometimes confused with writing a will or sorting out a power of attorney. Those things are related but different. Advanced care planning is specifically about health and personal care decisions — not financial or property decisions.
Why It Matters: The Reality Without a Plan
Without an advance care plan, the people caring for you — whether that's family members or medical professionals — have to make their best guess about what you would have wanted. That's an unfair burden to place on people who love you, and it often leads to conflict, distress, and decisions that may not reflect your actual values.
In New Zealand hospitals, when a patient deteriorates suddenly and there is no documented plan, clinical teams default to providing all available treatment unless there is a clear reason not to. For some people, that's exactly what they'd want. For others — particularly those with advanced illness or who have expressed a wish to avoid aggressive intervention — it can mean dying in circumstances they would never have chosen.
An advance care plan doesn't remove decision-making from your family. It supports them. It gives them something to point to and say: 'We know what Mum would have wanted.'
The Key Documents: What's Available in NZ
My Advance Care Plan (the standard NZ document)
Health New Zealand (Te Whatu Ora) has developed a standard advance care plan template called My Advance Care Plan. It's available from your GP, hospital, hospice, or online. It covers:
What matters most to you in life
Your understanding of your current health situation
What you would and wouldn't want in terms of treatment
Where you would prefer to be cared for if you became very unwell
Your wishes around dying, including preferred place of death
Who should be involved in decisions on your behalf
The document is not legally binding in the same sense as an EPA, but it is recognised and respected across New Zealand's health system. Completing it formally and sharing it with your GP means it can be noted on your records and accessed by other health providers.
Enduring Power of Attorney (EPA)
An EPA for personal care and welfare is the legal document that appoints someone to make decisions on your behalf if you lose mental capacity. It works alongside an advance care plan rather than replacing it. Your attorney is legally obliged to consider your previously expressed wishes — which is exactly what your advance care plan documents.
If you don't have a Welfare EPA and you lose capacity, decisions about your care could end up being made by people you wouldn't have chosen, or through a formal process involving the Family Court or the Office of the Public Guardian.
See our full guide to Enduring Power of Attorney for more on how to set one up.
Do Not Resuscitate (DNR) and CPR Decisions
A DNR order — sometimes written as DNAR (Do Not Attempt Resuscitation) — is a specific medical instruction, separate from an advance care plan. It's completed with your doctor and placed on your medical record. It means that if your heart stops, staff will not attempt cardiopulmonary resuscitation.
This is a medical decision that needs to be made in consultation with your clinical team. Your advance care plan can express a preference, but the formal order needs to come from a doctor based on your medical circumstances. If this is important to you, raise it explicitly with your GP or specialist.
Statement of Wishes
Some people also write a less formal 'statement of wishes' — a letter to their family or care team that captures values, preferences, and requests in their own words. This can complement a formal advance care plan and is particularly useful for expressing things that don't fit neatly into a structured form: your feelings about certain treatments, your wishes around visitors, your preferences about music, food, or spiritual care.
What Should Your Plan Cover?
A good advance care plan goes beyond tick-boxes. The most useful ones are specific enough to guide real decisions. Here are the areas most worth thinking through:
Where you want to be cared for
Most New Zealanders say they would prefer to die at home or in a hospice rather than in a hospital. But preference and planning are different things. If staying home is important to you, your advance care plan should reflect that — and your family needs to know what support would be required to make it possible.
What treatments you would or wouldn't want
Think about interventions that might be offered if you became seriously unwell: resuscitation, mechanical ventilation, artificial feeding, IV fluids, dialysis, admission to intensive care. You don't need to list everything — but if you have strong feelings about any of these, that's worth recording.
What 'quality of life' means to you
This is often the most important part. Some people would want all available treatment as long as there is any chance of survival, even if they might be left with significant disability. Others would prioritise comfort and dignity over life extension. Neither is right or wrong — but knowing where you stand helps enormously.
Your values and what matters most
What makes life meaningful to you? What would make life not worth living? What role does faith or culture play? What relationships are most important? These questions might feel abstract, but they anchor everything else in your plan.
Spiritual, cultural, and religious preferences
If your culture, faith, or community has specific practices around illness, dying, or death, these belong in your plan. This includes karakia, spiritual visitors, wishes around who is present at death, and preferences for the care of your body afterwards.
How to Start the Conversation
For many families, this is the hard part. Advanced care planning requires talking about decline, loss of independence, and death — things most of us avoid. But the conversations, once started, are rarely as difficult as people fear.
With your family
You don't need to have all the answers before you start. Begin with something like: 'I've been thinking about what I'd want if I got really sick. Can we talk about it?' Most people find their family is relieved to have permission to discuss something they were also privately worried about.
If someone close to you is resistant, try framing it differently: 'I want to make sure you're not put in a difficult position having to guess.' Most people find it easier to plan for someone else's peace of mind than their own.
With your GP
Your GP is the right starting point for medical aspects of your plan. Book a specific appointment for this — don't try to fit it into the last two minutes of a regular check-up. Tell them you want to talk about your future care wishes. They can note your preferences on your records, help you complete the formal plan, and refer you to palliative care or hospice services if that's relevant.
With a hospice team
Hospice services in New Zealand are not just for people who are actively dying. Hospice teams include specialist nurses, social workers, and counsellors who support people with life-limiting illness and their families — sometimes for months or years before death. If you or someone you care for has a serious illness, a hospice referral may be appropriate, and their team are expert at facilitating advance care planning conversations.
When Should You Start?
The honest answer is: earlier than you think. Advanced care planning is most useful — and least distressing — when done while a person still has full capacity, time to reflect, and no immediate crisis pressing. Waiting until someone is seriously ill puts enormous pressure on families and may result in a plan completed in haste or under duress.
A good prompt is any significant health event: a new diagnosis, a hospital admission, a fall, or simply a birthday that feels significant. But you don't need a reason. If you're reading this, you already have one.
Reviewing and Updating Your Plan
An advance care plan is not a once-and-done document. Your health circumstances change. Your values may shift. The person you've appointed as your EPA attorney may no longer be the right choice. Relationships evolve.
Most health organisations recommend reviewing your plan:
After any significant change in your health
After any major life event — bereavement, a move, a change in family relationships
Every one to two years, even if nothing has changed, just to confirm it still reflects your wishes
When you update your plan, let the relevant people know — your GP, your EPA attorney, and close family members. If you've given a copy to a hospital or specialist service, update them too.
Who Should Have a Copy?
Once your plan is completed, it needs to reach the right people to be effective:
Your GP (most important — they can note it on your records and share it with other providers)
Your EPA attorney for personal care and welfare
Close family members or whānau who might be involved in care decisions
Any specialist or rest home or retirement village where you receive care
Ambulance services, if you have a serious condition — ask your GP about this
Keep a copy somewhere accessible at home. Some people also carry a brief summary card in their wallet, particularly if they have a serious condition where emergency decisions might need to be made quickly.
Advanced Care Planning and Māori Whānau
For Māori, advanced care planning sits within a broader framework of whānau wellbeing and tikanga. Decisions about care, place of death, and what happens afterwards are often collective rather than individual — made by whānau together rather than documented by one person alone.
Many DHBs and hospice services across New Zealand have kaupapa Māori support workers or cultural advisors who can help facilitate advance care planning in a way that fits within a whānau framework. If this is important to you or your family, ask specifically for this support when approaching your GP or a hospice service.
The formal My Advance Care Plan document can accommodate cultural values, but it may also be supplemented by broader whānau conversations and agreement — the documented plan doesn't have to capture everything, as long as those who will be making decisions understand the full picture.
What Advanced Care Planning Cannot Do
It's worth being clear about the limits, too:
An advance care plan cannot guarantee your wishes will be followed in every situation — clinical circumstances may make some wishes impossible
It cannot override a doctor's clinical judgement in cases where a requested treatment would not be medically appropriate
It is not a legal substitute for an Enduring Power of Attorney — if you lose capacity and have no EPA, other formal processes may apply
It cannot authorise euthanasia or assisted dying beyond what is permitted under New Zealand's End of Life Choice Act 2019
What it can do is substantially increase the likelihood that your wishes are known, respected, and reflected in the care you receive.
The End of Life Choice Act 2019
New Zealand's End of Life Choice Act came into force in November 2021. It allows eligible people with a terminal illness likely to end their life within six months to request assisted dying. This is a separate legal process from advanced care planning and has its own criteria, safeguards, and documentation requirements.
If assisted dying is something you are considering or want to understand better, speak with your GP. They can provide information and, if they are not a conscientious objector, can begin the assessment process. If your GP objects, they are required to refer you to someone who does not.
Getting Help to Create Your Plan
You don't have to do this alone. The following can support you through the process:
Your GP — the most important first contact
Hospice New Zealand — free planning resources and local hospice services nationwide
Health New Zealand (Te Whatu Ora) — provides the My Advance Care Plan document
Age Concern NZ — community support and advocacy for older people
Your local hospice — many run advance care planning workshops
Related Guides
Hospice Care NZ: What It Is and How to Access It