How to Appoint a Medical Treatment Decision Maker in Victoria

Why Victoria Separates Medical Decisions From Everything Else

If you've set up an enduring power of attorney (EPA) in Victoria covering financial and personal matters, you might assume it also covers medical decisions. It doesn't.

Victoria operates under a dual-statute framework. Financial and personal decision-making falls under the Powers of Attorney Act 2014. Medical treatment decisions fall under a completely separate law — the Medical Treatment Planning and Decisions Act 2016, which commenced on 12 March 2018.

Under this framework, only a formally appointed Medical Treatment Decision Maker (MTDM) can consent to or refuse medical treatment on your behalf when you lose capacity. Your EPA attorney — even if they have authority over every aspect of your finances and personal life — has no standing in a hospital setting.

What an MTDM Can Do

An MTDM is authorised to:

• Consent to or refuse medical treatment (including surgery, medication changes, and dental procedures)
• Consent to or refuse clinical research participation
• Make decisions about ongoing treatment when you can no longer express your own wishes

The MTDM must make decisions based on what they reasonably believe you would have wanted — considering your values, any prior conversations about care preferences, and any advance care directive you've made.

An MTDM cannot:

• Make financial decisions
• Make personal or lifestyle decisions (living arrangements, diet, social activities)
• Override a valid instructional directive in your advance care directive
• Consent to treatment that you've specifically refused in a binding instructional directive

The Appointment Process

Step 1: Choose your MTDM. You can appoint any adult who isn't your paid carer, health practitioner, or accommodation provider. You can only appoint one MTDM at a time (unlike EPAs, which allow multiple attorneys). You should also name an alternative MTDM in case your primary appointee is unable or unwilling to act when needed.

Step 2: Complete the official form. The Department of Health Victoria provides the Appointment of Medical Treatment Decision Maker form as a free download. Use the current version — the 2016 Act introduced specific prescribed content that must appear in the form for it to be valid.

Step 3: Sign in front of two witnesses. This is where the requirements diverge significantly from EPA witnessing. For an MTDM appointment:

• Two adult witnesses must be present
• One witness must be a registered medical practitioner (a doctor — not just an authorised affidavit witness)
• Neither witness can be the person being appointed as MTDM

The registered medical practitioner requirement is stricter than for EPAs, which accept lawyers and JPs as the qualified witness. For MTDM appointments, a GP or specialist must be physically present to witness the signing.

Step 4: Remote witnessing is not available. Unlike EPAs, MTDM appointments cannot be witnessed via audio-visual link. The 2016 Act does not include the remote witnessing provisions that the Powers of Attorney Act 2014 now has permanently. In-person witnessing only.

Step 5: Your MTDM signs an acceptance. The appointed MTDM must sign a statement accepting the appointment. The appointment isn't legally active until this step is complete.

Step 6: Distribute copies. Give certified copies to your MTDM, your GP, your specialist if you have one, and any hospital or aged care facility where you receive regular care. Victoria has no central registry for MTDM appointments, so the physical document is the only proof of the appointment.

The Advance Care Directive Option

Alongside (or instead of) appointing an MTDM, you can make an Advance Care Directive (ACD). An ACD lets you document your treatment preferences directly, rather than delegating them to another person:

• A values directive records your general quality-of-life preferences and beliefs about treatment. It guides decision-makers but isn't legally binding.
• An instructional directive makes specific, legally binding statements of consent or refusal for defined medical treatments. A medical practitioner must follow an instructional directive directly — it overrides the views of the MTDM, the family, and the treating team.

Victoria's instructional directive is one of the strongest patient-autonomy mechanisms in Australia. If you've stated in an instructional directive that you refuse a specific intervention, no one — not your MTDM, not your family, not the hospital — can override that instruction.

ACD witnessing follows the same rules as MTDM appointments: two witnesses, one must be a registered medical practitioner, in-person only.

When There's No MTDM in Place

If you lose capacity without having appointed an MTDM, Victoria's statutory hierarchy kicks in. The law designates a default decision-maker in this order:

1. A VCAT-appointed guardian with medical powers
2. Your spouse or domestic partner
3. Your primary carer (unpaid)
4. Your oldest adult child
5. Your oldest parent
6. Your oldest adult sibling

This hierarchy is automatic — no application is needed. But it can create problems when family members disagree, when the first-listed person isn't available, or when the statutory hierarchy doesn't match who the person would actually have chosen.

Coordinating With Your EPA

For complete coverage, most Victorians need three documents:

1. An EPA for financial and personal matters
2. An MTDM appointment for medical decisions
3. An advance care directive if they want to document specific treatment preferences

Our Victoria Power of Attorney Kit walks through all three instruments together — execution requirements, witnessing differences, and how to coordinate them so that one trusted person (or a small team) covers every category of decision-making.

See more Victoria guides →