Advance health directives and who decides your care in Queensland

The Queensland equivalents of enduring guardianship

Three mechanisms cover the ground that other states call guardianship. They work together rather than as alternatives.

• Advance health directive (AHD) — your own written instructions about future treatment, including life-sustaining measures, made on the approved form with a doctor's certificate.
• Enduring power of attorney for personal and health matters — appoints a person to make health, accommodation and lifestyle decisions for you if you lose capacity.
• Statutory health attorney — the default decision-maker if you appointed nobody: your spouse, then an unpaid adult carer, then a close adult relative or friend, and finally the Public Guardian.
• Queensland Civil and Administrative Tribunal (QCAT) — can appoint a guardian or administrator where there is conflict, abuse, or no suitable person available.

What an advance health directive can do

An AHD speaks for you when you cannot speak for yourself. It can give general values and preferences, and it can give specific directions about treatments you would accept or refuse in defined circumstances — including cardiopulmonary resuscitation, assisted ventilation, artificial nutrition and hydration, and antibiotics for a life-threatening infection.

Directions about withholding or withdrawing life-sustaining measures only operate in the circumstances set out in the legislation, such as terminal illness, a persistent vegetative state, permanent unconsciousness, or an illness with no reasonable prospect of recovery to the point of surviving without the measure. A doctor must complete part of the form, confirming you understood the nature and effect of the directions.

Choosing who decides

If you want someone specific to make health and accommodation decisions, appoint them for personal and health matters in an enduring power of attorney. Without that appointment, the law picks for you, in a fixed order, and the person it picks may not be the person you would have chosen — an estranged spouse ranks ahead of a devoted adult child.

You can appoint different people for financial matters and for personal and health matters. Many families appoint one child who lives close by for health decisions and another with financial experience for money, though joint appointments need to be workable in a hospital corridor at 2am.

• Choose someone who will actually be contactable and available
• Tell them where the documents are kept and give a certified copy to the GP
• Discuss your values before there is a crisis, not during one
• Consider naming an alternative if your first choice cannot act

How decisions must be made for you

Attorneys, guardians and statutory health attorneys are bound by the General Principles and the Health Care Principle in the Queensland legislation. They must presume capacity, use the least restrictive option, take account of your known views and wishes, and support you to take part in the decision as far as you are able. A valid direction in an advance health directive overrides a substitute decision-maker's view.

Reviewing and revoking

An advance health directive should be reviewed every couple of years and after any significant change in health, and it can be revoked or replaced while you have capacity. An enduring power of attorney for personal matters is revoked in writing in the approved way — telling the attorney verbally is not enough. Marriage, divorce and separation can each affect these documents, so review them whenever your relationships change.

Frequently asked questions