Decision-making for someone at the end of life
Decision-making at the end of life
In Australia, the law recognises a person's right to control their own life. You are presumed to have the capacity to make decisions for yourself unless proven otherwise.
Sometimes, a family member or close friend may need your help to make decisions. This may include making important healthcare decisions.
Decision-making on behalf of someone at the end of life who has lost capacity can be an emotional experience. Often, decisions will be difficult, especially for those who have never had to make healthcare decisions for someone else before.
When making decisions on someone else's behalf, the decisions made must be in the person's best interests, preserve their dignity and not impose any unnecessary restrictions on them. As far as possible, any views the person has expressed previously should be taken into account.
Unless it is an emergency and a decision is required immediately, the healthcare team will give you time to make an informed decision. If the person has nominated other people to be a substitute decision maker, you will have to consult with them too.
Statutory health attorney
If there isn't any formal paperwork, you may be what is called a 'statutory health attorney' for the person you are caring for. Although not formally appointed, statutory health attorneys are considered substitute decision-makers and must be both readily available and appropriate for the role.
Statutory health attorneys can be (listed in order of priority):
- a spouse if the relationship is close and continuing; if not, then
- a person over 18 who is not a paid carer; if not, then
- a person who is 18 years or more and who is a close friend or relation of the adult and is not a paid carer
Typically, you will know in advance if you are going to be a substitute decision-maker for your loved one.
Remember, you can only act as the person’s substitute decision-maker if the person loses their capacity.
Difference between a carer and substitute-decision maker
In legal terms, there is a difference between a carer and an appointed substitute decision-maker. The difference depends upon whether you are formally appointed as a substitute decision-maker.
If the person in your care has made an enduring power of attorney (for health matters) or an advance health directive appointing you as their health attorney, you have been formally appointed.
In this case you would become the legally appointed substitute decision-maker as well as the person’s carer and/or family member.
Who is a substitute decision-maker?
A substitute decision-maker is a person who can legally make important decisions on behalf of someone who does not have capacity to make their own decisions. The decisions can be about health or financial matters. They can be a family member, carer and a legally appointed substitute decision-maker all at the same time.
A substitute decision-maker can be appointed formally through:
- an order of the Queensland Civil and Administrative Tribunal (QCAT)
- an enduring power of attorney (EPOA)
- an advance health directive
Find out more about substitute decision-makers.
Information for people appointed as an enduring power or attorney
- How to act appropriately as an attorney under an enduring power of attorney (EPOA) in Queensland
- My duties and responsibilities as an Attorney under an EPOA in Queensland (PDF, 830KB)
- ADA Australia flyers and factsheets