Culturally Safe Advance Care Planning for Aboriginal and Torres Strait Islander Peoples: An Expert Guide

Introduction

Advance Care Planning (ACP) is a vital process supporting people to express their values, preferences, and wishes about future healthcare. For Aboriginal and Torres Strait Islander peoples, ACP must be grounded in cultural safety—respecting kinship, community decision-making, connection to Country, and holistic wellbeing. This article provides an expert, in-depth review of culturally safe ACP for First Nations peoples, explores key cultural influences, and illustrates the role of secure platforms like Evaheld in preserving stories, wishes, and consent.

1. The Foundations of Culturally Safe Advance Care Planning

1.1 What is Advance Care Planning?

Advance Care Planning empowers individuals to plan and communicate their future healthcare preferences in case they become unable to make or express decisions. This can include discussions, documents (like Advance Care Directives), and nominating substitute decision makers.

1.2 Cultural Safety in ACP

Cultural safety is an “enabling environment, safe for people; where there is no assault, challenge or denial of their identity, of who they are and what they need. It is about shared respect, shared meaning, shared knowledge and experience, of learning together with dignity, and truly listening” (National Safety and Quality Health Service Standards on Cultural Safety).

For First Nations peoples, cultural safety means services and systems must:

Respect Aboriginal and Torres Strait Islander ways of knowing, being, and doing.
Recognize the ongoing impacts of colonization, racism, and trauma.
Engage with communities, Elders, and families as equal partners.
Facilitate self-determination and uphold human rights in healthcare.

2. Kinship, Community, and Country in Decision-Making

2.1 Kinship and Family Structures

Aboriginal and Torres Strait Islander kinship systems affect every aspect of life, including healthcare. Decision-making is collective—family members, Elders, and extended kin are often involved. Nominated decision makers may not align with Western notions (e.g., legal next of kin), so processes must honor family structure and preference (Advance Care Planning Australia resource).

2.2 Community Decision-Making

Community consultation is a core value. Community leaders, Elders, and health workers can help facilitate and support ACP. Consent and decision-making may require community or family meetings. Culturally safe ACP supports collective, not just individual, decision-making.

2.3 Connection to Country and Spirituality

Connection to Country—the land, waters, ancestors, and spiritual beliefs—is central to health and dying well. End-of-life decisions may reflect spiritual values, wishes to return to Country or community, and specific cultural rites (Palliative Care Australia resource).

3. Best Practices: Culturally Safe Advance Care Planning

3.1 Building Trust and Engagement

Use interpreters: Many First Nations peoples speak Aboriginal languages or creoles. Healthcare interpreters should be used to accurately communicate choices and wishes.
Develop relationships: Trust is built over time through respectful, transparent interactions.
Involve Aboriginal Health Workers: They provide a bridge between Western healthcare and First Nations communities.
Acknowledge history and experience: Be aware of historical trauma and ongoing discrimination.

3.2 Facilitating Inclusivity

Create opportunities for storytelling and yarning (informal conversations), enabling people to share wishes in their own words and time.
Respect non-written preferences: Stories, oral history, and non-document-based communication may be preferred.
Provide translated resources and information in relevant languages (Health.gov.au resources).
Allow flexibility in documentation to reflect cultural concepts not captured in standard forms.

ACP conversations should include the person, their family, community Elders, and significant others as chosen by the individual.
Honour collective decision-making and the authority of Elders in giving consent for information sharing or healthcare decisions.

3.4 Spiritual and Traditional Care

Ask about and accommodate cultural rites and spiritual practices at the end of life, including ceremonies and returning to ancestral lands.
Partner with traditional healers where appropriate and desired.

3.5 Flexible ACP Documentation

Recognise and support alternative forms of documenting wishes—audio recordings, video stories, and trusted oral agreements.
Use technology and digital tools that allow for culturally relevant, non-written recording of ACP wishes.
Support the inclusion of information about spiritual, ceremonial, and communal aspects of care.

4. Legal and Ethical Considerations

Ensure compliance with state and territory laws, but be flexible and inclusive in how wishes are documented.
Protect the privacy and cultural intellectual property of First Nations peoples when storing or sharing ACP information.
Support the right to self-determination and uphold indigenous health rights in every step of ACP.

5. Digital Preservation: How Evaheld Supports Cultural Safety

Digital platforms like Evaheld provide secure, culturally sensitive storage for ACP wishes and stories:

Culturally Secure Storage: Evaheld enables First Nations peoples to store their stories, wishes, and consent digitally, with access and privacy controls that respect community and cultural protocols.
Multi-Format Documentation: Evaheld accepts oral histories, audio/video files, and creative storytelling—not just written documents.
Consent and Community Oversight: Community and family can be part of the permission process, upholding collective consent and privacy.
Reflecting Country and Kin: Preferences about returning to Country, nominating kin or community custodians, and including spiritual beliefs can be preserved.
Permanent Record: Wishes and directives are accessible to health services (with consent), helping ensure that care aligns with the person's culture and community even if they move between locations.

6. National Standards, Policies, and Resources

The National Aboriginal and Torres Strait Islander Health Plan 2021–2031 sets policy direction to improve health and wellbeing, emphasizing culturally safe, person- and family-centred care.
Palliative Care Australia provides frameworks for culturally appropriate end-of-life care.
Advance Care Planning Australia publishes guidance and resources tailored for First Nations peoples, including family involvement and community leadership.
The Australian Commission on Safety and Quality in Health Care outlines standards for cultural safety and person-centred care.
Healthdirect provides information and tools for both the public and professionals.

7. Community Engagement and Workforce Development

Invest in Aboriginal and Torres Strait Islander workforce development: More Aboriginal health professionals and interpreters means safer, more inclusive ACP.
Continuous Cultural Safety Training: All healthcare professionals should have ongoing training in cultural safety, community engagement, and trauma-informed care.
Engage in partnerships with community-controlled health services for local leadership and knowledge.

Plan ahead with confidence — create your free Advance Care Plan in the Evaheld Legacy Vault to record your healthcare wishes, appoint decision-makers, and give your loved ones clarity, comfort, and peace of mind.

8. Storytelling, Oral History, and Technology in ACP

Storytelling and yarning are culturally resonant ways for First Nations people to share their life, values, stories and preferences. These stories, captured respectfully, can guide health workers in providing culturally safe care.
Secure oral and digital forms of ACP, such as those enabled by Evaheld, can preserve essential details that might be lost in standard paperwork.
Community-driven digital solutions can support truth-telling, reconciliation, and culturally safe sharing of knowledge across generations.

9. Overcoming Barriers and Moving Forward

Address health literacy and empower families and communities with accessible ACP information.
Foster environments where First Nations peoples feel safe, respected, and included in healthcare conversations.
Remove practical, legal, linguistic, and cultural barriers to participation in ACP.

Conclusion

Culturally safe Advance Care Planning for Aboriginal and Torres Strait Islander peoples requires commitment to respect, partnership, and self-determination. Kinship, community, and connection to Country profoundly influence how wishes are expressed and decisions are made. Secure digital platforms like Evaheld can help preserve stories, wishes, and community consent, ensuring First Nations voices are honored across the healthcare journey.

For healthcare professionals and services seeking to do better, partnering with communities, investing in cultural safety education, harnessing inclusive technology, and always listening are the best routes to improving health equity and honoring the dignity and wisdom of Australia’s First Peoples.

Further Resources

Summary: Culturally safe Advance Care Planning for Aboriginal and Torres Strait Islander peoples ensures people's voices, stories, and rights are respected. Central to these processes are kinship, community, and connection to Country. Modern digital solutions like Evaheld now enable these wishes and histories to be recorded, protected, and rightfully preserved—supporting a healthier, more just future for all.

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