Can a Doctor Override Your Advance Directive in Tasmania?

The Short Answer: Yes, Under Specific Conditions

A Tasmanian Advance Care Directive is legally binding — but it is not absolute. Section 35U of the Guardianship and Administration Act 1995 gives clinicians the legal authority to override your directive in defined circumstances. Understanding when and why this happens is the difference between a directive that actually protects your autonomy and one that gets set aside during the exact emergency it was designed for.

When Section 35U Allows a Clinical Override

The Act permits a health practitioner to depart from your ACD in the following situations:

The Directive Is Clinically Inappropriate

If your treating doctor determines that the specific instruction in your ACD is clinically impossible to carry out in the current medical situation, they can override it. The most common example is a directive that requests CPR but refuses intubation and mechanical ventilation. In clinical practice, CPR and airway management are inseparable — a person whose heart has stopped is not breathing independently, and chest compressions without an airway are medically futile. A paramedic or emergency physician facing this contradiction will default to full active treatment.

The Directive Does Not Apply to the Current Situation

If a clinician has reasonable grounds to believe that you did not intend a provision in your ACD to apply in the particular circumstances, or that it does not appear to reflect your current wishes, Section 35U permits the clinician not to comply with that provision. Before doing so, the clinician must make reasonable efforts to consult the authorised decision-maker.

The Directive Is Ambiguous or Contradictory

Vague language kills directives. Phrases like "no extraordinary measures," "no heroic treatment," or "I do not want to be kept alive artificially" have no standardised clinical definition. During an emergency, when a clinician cannot determine what specific interventions you intended to refuse, they are legally and ethically required to default to active treatment. The directive is not technically overridden — it simply cannot be executed because no one can determine what it means.

Reasonable Grounds to Doubt Validity

If a clinician has reasonable grounds to believe the ACD was not made voluntarily, that you lacked decision-making ability when you signed it, or that the document does not comply with the statutory requirements (missing witnesses, wrong form, unsigned), it may not be valid under Part 5A and may not bind the clinician. These are validity issues, separate from the Section 35U grounds above.

What Section 35U Does Not Allow

A doctor cannot override your ACD simply because they disagree with your medical choices. If you have made a clear, specific, properly witnessed refusal of a particular treatment — and that refusal applies to your current clinical situation — the treating team is legally bound to respect it, even if they believe the treatment would benefit you.

Family members also cannot override your ACD. Your Enduring Guardian has the authority to make decisions on matters your directive does not cover, but the guardian cannot contradict a clear, applicable instruction in the ACD itself. If your directive says "I refuse mechanical ventilation in the event of a terminal illness," your guardian cannot consent to ventilation on your behalf.

How to Write an Override-Resistant Directive

The primary reason ACDs get overridden is not bad faith by clinicians — it is vague drafting by the person who made the directive. You can dramatically reduce the risk by:

Using specific clinical terminology. Instead of "no life support," write "I refuse cardiopulmonary resuscitation, endotracheal intubation, mechanical ventilation, and artificial nutrition and hydration." Name each intervention individually.

Defining your trigger conditions. State the medical circumstances under which your refusals apply. "If I have a terminal illness with no reasonable prospect of recovery" is clearer than "if my quality of life is unacceptable." Better still: "If two independent medical practitioners certify that I have an irreversible condition with a life expectancy of less than six months."

Aligning with hospital GOC categories. The Tasmanian Health Service uses a Medical Goals of Care Plan with four phases (A through D). When your ACD language maps directly to these clinical categories, the admitting doctor can translate your wishes into a GOC order without interpretation gaps.

Avoiding medical contradictions. Review your refusal clauses for internal consistency. The CPR-without-intubation contradiction is the most common, but others exist — refusing blood transfusions while requesting surgical intervention for trauma, for example.

Getting a GP capacity note. Ask your GP to document a formal capacity assessment at the time you make the ACD. This medical note, stored alongside the directive, makes it significantly harder for anyone to challenge the directive on the grounds that you lacked capacity.

What to Do If You Are Concerned About Override

If you are worried that your family or treating team might override your wishes — perhaps because family members disagree with your decisions, or because you have a complex medical history — consider taking two additional steps:

1. Register your ACD with TASCAT. Registration creates a formal, searchable state record that is harder to dispute or ignore than an unregistered document.

2. Brief your Enduring Guardian. Under the September 2024 amendments, your guardian is legally required to have read and understood your ACD. Make sure they know exactly which treatments you have refused and why. A guardian who can articulate your reasoning to a treating team is a powerful safeguard against clinical override.

Getting the Language Right

The Tasmania Advance Directive & Living Will Kit includes a GOC alignment worksheet that walks you through drafting refusal clauses that map directly to the clinical categories Tasmanian hospitals use — minimising the ambiguity that triggers Section 35U overrides. The kit also covers the signing, witnessing, and registration process to ensure your directive meets every statutory requirement.

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