Can Doctors Ignore an Advance Health Directive in Western Australia?

The Short Answer: Usually No, but There Are Narrow Exceptions

A validly executed Advance Health Directive (AHD) in Western Australia is legally binding. Under Part 9B of the Guardianship and Administration Act 1990, the AHD sits at the absolute top of the hierarchy of treatment decision-makers. A treating doctor should follow a valid, applicable directive unless a recognised exception applies.

But "valid" and "applicable" carry weight. WA law builds in specific circumstances where a doctor can decline to follow an AHD. Understanding those circumstances is the difference between a directive that works in a crisis and one that gets set aside.

When a Doctor Can Legally Deviate

1. The directive is vague or clinically uninterpretable.

If your AHD says "no heroic measures" or "I don't want to be kept alive artificially," the medical team faces a problem: those phrases have no standardised clinical meaning. Does "heroic measures" include IV antibiotics? Does "artificial" cover a temporary feeding tube after surgery? Different doctors will interpret the same phrase differently.

WA law does not allow doctors to ignore an AHD on grounds of vagueness alone, but clinically uninterpretable instructions create a practical gap. The doctor may conclude that the directive does not clearly apply to the specific situation and move to the next person on the hierarchy of treatment decision-makers — your enduring guardian or family — for guidance.

The fix: write specific, clinical instructions. "I refuse mechanical ventilation if I am diagnosed with a persistent vegetative state" is unambiguous. "No life support" is not.

2. The 10-year "reading down" rule.

The Guardianship and Administration Act 1990 allows a clinician to "read down" — effectively reconsider — an AHD that was made more than ten years ago. The test considers the maker's age at the time, the time that has elapsed, and whether medical advances have fundamentally changed the treatment landscape.

For example, a directive refusing cardiac intervention that was written in 2015 might be read down in 2026 because modern cardiac surgery has lower mortality rates and faster recovery times than the maker could have anticipated. The doctor must assess whether the changed circumstances affect the directive's validity or application; if it no longer applies, the hierarchy may be used.

This does not mean an old AHD is worthless. It means the older the directive, the more clinical scrutiny may be required. A review can help show that it remains current; if you want to change it, revoke the signed directive and make a new one.

3. Treatment would be clinically futile.

An AHD can refuse treatment, but it cannot compel treatment a doctor considers clinically futile. If your directive requests "all available treatment to keep me alive," the treating team is not obligated to perform CPR on a body that will not respond to resuscitation, or to ventilate a patient whose organs have irreversibly failed.

This is not a loophole — it is a clinical reality. A valid refusal is generally followed when it applies, subject to the statutory exceptions above. The right to demand treatment is constrained by medical judgment.

4. The directive does not apply to the current clinical situation.

An AHD that addresses cardiac failure does not automatically apply to a decision about whether to treat an unrelated pneumonia. If the clinical scenario falls outside the scope of what you documented, the directive is silent on that point, and for non-urgent treatment the doctor must seek consent from the next person on the hierarchy.

5. Urgent treatment cannot wait for the paperwork. If urgent treatment is needed to save life or prevent significant pain or distress, and it is not practicable to determine whether an AHD exists or obtain a treatment decision from the hierarchy, the health professional may provide the necessary treatment. If the urgent treatment is believed to result from attempted suicide, it may be provided even if the AHD withholds consent.

When a Doctor Should Follow the Directive

If your AHD is:

• Validly executed (proper witnesses, mandatory sections completed)
• Less than ten years old
• Specific and clinically interpretable
• Directly applicable to the current treatment decision

Then the treating doctor should follow it, subject to the limited exceptions above. Even if your family objects. Even if the medical team believes the decision is not in your best interest. Even if the enduring guardian disagrees. The AHD overrides all of them when it is valid and applicable.

If you believe a valid, applicable AHD has not been followed, ask the treating service to review the decision and consider advice from the Office of the Public Advocate or the State Administrative Tribunal.

Voluntary Assisted Dying: A Hard Boundary

The one treatment decision an AHD absolutely cannot authorise is Voluntary Assisted Dying (VAD). The Voluntary Assisted Dying Act 2019 requires the patient to maintain decision-making capacity throughout the entire process. An AHD activates when capacity is lost, so the two frameworks cannot intersect. This is not a case of doctors ignoring a directive — it is a statutory exclusion baked into WA law.

Protecting Your Directive

Three practical steps to make sure your AHD survives clinical scrutiny:

1. Be specific in Part 4. Name the clinical scenarios. Name the treatments you refuse or consent to. Use the same language the statutory form provides — it was designed for clinical clarity.

2. Review every few years. Whether you have reviewed the directive, and how long ago the review occurred, are factors considered when its validity is assessed. Keep a record of the review with the directive.

3. Upload to My Health Record. A directive in a filing cabinet at home is invisible to an emergency department at 2 AM. Upload it via myGov (scan in black-and-white at 300 dpi) so healthcare professionals with access to My Health Record can retrieve it electronically.

The Western Australia Advance Directive & Living Will Kit includes clinician-tested language for Part 4 treatment decisions, a review schedule template, and a My Health Record upload walkthrough — designed to make your directive as robust as possible.

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