Health Minister David Davis said these so-called ''instructional healthcare directives'' were about giving people the choice to reject treatment which could simply make their life ''unpleasant, uncomfortable and may, in some cases, be futile''. ''I strongly support the ability of people, with their families, to make clear their wishes ahead of time, in terms of medical treatment,'' Mr Davis told The Sunday Age. The proposal is one of 440 recommendations by the commission to overhaul Victoria's guardianship laws. But the commission's report, which was tabled in State Parliament last week, has made clear that any legislative change should not allow healthcare directives to authorise euthanasia or assisted suicide. It also recommends giving doctors the right to refer their patient to another doctor if they are unable to comply with an instruction due to their personal views or beliefs. And in another safeguard, it allows the directive to be quashed if there are medical advances that might not have existed when the patient first issued it. Commission acting chairman David Jones said the proposal was designed to empower people to make decisions about their own lives, while they are still capable of doing so.

"Otherwise what happens is that … people lose the capacity to make the decision themselves," Mr Jones said. "This can result in family difficulties - for instance, where someone says: 'no, we want mum to get treatment so she can go on living' while other members of the family say 'no, she's got no quality of life, she wouldn't have wanted this'.'' The report follows an extensive inquiry commissioned in 2009 by the former Labor government. It also recommends: ■Giving the Victorian Public Advocate unprecedented powers to investigate exploitation, abuse or neglect of the elderly or disabled, including the right to seize documents and enter homes. ■Creating a new legal role - known as a "supporter" - to help people with cognitive impairment make their own decisions. ■Lowering the age of guardianship from 18 to 16.

Allowing people not yet cognitively impaired to set directives about future medical treatment could prove politically sensitive for the government. John Chesterman, policy manager for the Office of the Public Advocate, said having the capacity to make decisions over your own medical treatment was important. "We're mindful of the need to keep safeguards in place and to make sure all steps are taken to ensure the social wellbeing of the person.'' Australian Medical Association Victoria president Harry Hemley welcomed the proposal, saying ''it will provide patients, especially our elderly patients, the opportunity to have a dignified death''. Associate Professor Bill Silvester, director of the Respecting Patient Choices Program, said: ''There have been so many cases where doctors have given patients treatment that they didn't want. This would protect people in the future, in a way that we're not protected at the moment.'' Mr Davis said there had already been some moves at hospitals to facilitate advanced directives. ■ftomazin@theage.com.au