Advance Directive Ignored by Hospital in QLD: What Families Can Do

When It Feels Like the Hospital Is Ignoring the Directive

The call from a family member usually sounds something like this: "Mum has an Advance Health Directive that says no life support, but the hospital put her on a ventilator anyway." It's distressing, and the first instinct is to assume the hospital is acting illegally. But the reality in Queensland is more nuanced than a straightforward "they broke the law."

There are several reasons a treating team might appear to deviate from an AHD, and understanding which one applies to your situation determines what to do about it.

Reason 1: The AHD Language Is Ambiguous

This is the most common reason, and it's the one most families don't anticipate. Under the Powers of Attorney Act 1998, an AHD's treatment directions are legally binding — but only when they clearly and specifically apply to the patient's current clinical situation.

When the language is vague — "no heroic measures," "no artificial life support," "let nature take its course" — the treating team faces a judgment call. Does "artificial life support" include supplemental oxygen? IV antibiotics? A feeding tube? A ventilator for a few hours while a reversible condition is treated?

Clinicians who are uncertain default to treatment. This isn't defiance — it's a liability-driven response. A doctor who withholds treatment based on an ambiguous directive and the patient dies faces potential negligence claims. A doctor who provides treatment and the patient survives faces fewer legal consequences, even if the patient's AHD theoretically prohibited that treatment.

This is the ambiguity loophole, and it's the single most important reason to use precise clinical language in an AHD. "I refuse mechanical ventilation via endotracheal intubation if I have a terminal illness with no reasonable prospect of recovery and two doctors agree that death is expected within one year" identifies the treatment and the statutory threshold. "I don't want machines keeping me alive" is not.

Reason 2: The Clinical Threshold Isn't Met

Certain life-sustaining treatment refusals in an AHD only activate under specific clinical conditions. Under Queensland law, directions to withdraw or withhold life-sustaining measures don't operate unless:

• The patient has a terminal illness with no reasonable prospect of recovery, and the treating doctor and another doctor agree that death is expected within one year, or
• The patient is in a persistent vegetative state with no reasonable prospect of cognitive recovery, or
• The patient is in a permanent coma with no reasonable prospect of regaining consciousness, or
• The illness or injury is of such severity that the patient will permanently require life-sustaining treatment to survive

If the treating team determines that the patient's condition doesn't meet any of these thresholds — even if the patient is seriously ill — they may continue treatment because the AHD's directions haven't legally "activated." This happens most often with acute events (heart attack, stroke, pneumonia) that are potentially reversible, even in elderly or chronically ill patients.

Reason 3: The Hospital Didn't Know the AHD Existed

Surprisingly common. An AHD sitting in a filing cabinet at home provides no guidance to the emergency department team treating the patient at 3am. If the directive wasn't uploaded to The Viewer (Queensland Health's electronic record system) and nobody brought a physical copy to the hospital, the treating team has nothing to work with.

Ambulance paramedics can check The Viewer via their electronic patient care system, and hospital clinicians check it during admission — but only if the document has been uploaded via the Statewide Office of Advance Care Planning. Physical copies kept only at home, or only with the GP, may not reach the treating team in time.

Reason 4: A Separate Mental-Health Treatment Framework

For patients being treated under an involuntary treatment order under the Mental Health Act 2016, a separate mental-health treatment framework applies. Psychiatric treatment may therefore not follow a mental-health preference in the same way as a general AHD direction; the effect depends on the order and the clinical circumstances.

What to Do When You Believe the AHD Is Being Ignored

Step 1: Speak to the treating doctor directly. Ask for a specific explanation of why the AHD's directions aren't being followed. Is it an ambiguity issue? A clinical threshold issue? An access issue? The answer determines the next step.

Step 2: Produce the document. If the hospital didn't have access to the AHD, provide a physical copy immediately. Ask the treating team to review it and update the patient's clinical record and Acute Resuscitation Plan (ARP) accordingly.

Step 3: Invoke the attorney's authority. If you're the appointed attorney under an EPOA with health powers, you have standing to consent to or refuse treatment on the patient's behalf — for any decisions not already covered by the AHD's specific directions. Clearly communicate your decision to the treating team, in writing if necessary.

Step 4: Escalate within the hospital. Ask to speak with the patient advocate, the after-hours nursing supervisor, or the director of medical services. These roles exist to resolve clinical-ethical disputes within the hospital system.

Step 5: Contact the Office of the Public Guardian. If the person has impaired capacity or there are concerns about their rights or abuse, the OPG can provide relevant oversight or guidance. Ask the OPG where a complaint about the hospital's treatment or handling of the document should be directed.

Step 6: Lodge a formal complaint. If the hospital has genuinely failed to follow a valid, specific AHD without lawful justification, you can complain to the Health Ombudsman Queensland (Office of the Health Ombudsman). They investigate complaints about Queensland health service providers, including public and private hospitals.

Preventing the Problem in the First Place

Most "ignored directive" situations are preventable:

• Upload to The Viewer via the Statewide Office of Advance Care Planning — this is the single most impactful step
• Use specific clinical language in the treatment-direction sections of Form 4 — name the treatments, name the circumstances
• Give copies to the GP, the attorney, and family members who can produce the document at the hospital
• Review and update after any significant health change — a directive written at 55 may not address the clinical realities at 80

The Queensland Advance Directive & Living Will Kit includes clinical phrasing templates designed to minimise ambiguity, a storage and distribution checklist, and a guide to the complaint pathways when things go wrong.

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