Statement of Choices vs Advance Health Directive QLD
They Look Similar but Work Very Differently
Queensland has two main documents for recording your healthcare preferences: the Statement of Choices (Form A or Form B) and the Advance Health Directive (Form 4). Both deal with future medical care. Both are used by hospitals and clinicians. But their legal status is fundamentally different — and confusing them is one of the most common planning mistakes in Queensland.
The Statement of Choices records your values, your quality-of-life preferences, and your general wishes about care. It's a guide for clinicians and substitute decision-makers. It is not legally binding.
The Advance Health Directive records specific, binding instructions about medical treatments you consent to or refuse. It is legally binding on healthcare providers when it was properly executed and the clinical situation matches your directions.
This distinction matters enormously when you're unconscious in an emergency department and a doctor needs to decide whether to intubate you.
What Each Document Actually Does
Statement of Choices (Form A and Form B)
Form A is completed while you have capacity. You record:
- What matters most to you in daily life (independence, family connection, comfort)
- Your preferences about where you'd like to receive care
- Cultural, spiritual, or religious considerations
- Who you'd like involved in decisions about your care
- General treatment preferences (comfort-focused care vs active treatment)
Form B is completed by an appropriate substitute decision-maker or person with a close and continuing relationship when you've already lost capacity. It records what they believe your preferences are, based on conversations and observations.
Both forms are used extensively in aged care facilities and hospitals to guide clinical decision-making. Nurses and doctors consult them when deciding treatment approaches, especially for patients who can't communicate. They're particularly valuable for the everyday care decisions that an AHD doesn't cover — how to manage pain, whether to transfer to hospital for a minor infection, whether to continue physiotherapy.
But when a critical decision arrives — to resuscitate or not, to intubate or not, to start dialysis or not — the Statement of Choices provides guidance, not instructions. A doctor can consider it, weigh it, and ultimately make a different decision if they believe it's clinically appropriate.
Advance Health Directive (Form 4)
The AHD operates at a different legal level. Under the Powers of Attorney Act 1998, it records specific treatment decisions that doctors must follow when the directions are valid and applicable. You specify:
- Which treatments you consent to (e.g., "I consent to blood transfusions")
- Which treatments you refuse (e.g., "I refuse mechanical ventilation")
- The conditions under which refusals take effect (the four statutory triggers: a terminal illness with no reasonable prospect of recovery where the treating doctor and another doctor agree that death is expected within one year; a persistent vegetative state with no reasonable prospect of cognitive recovery; a permanent coma with no reasonable prospect of regaining consciousness; or an illness or injury of such severity that the person will permanently require life-sustaining treatment to survive)
- Whether you're appointing an attorney for health decisions
The execution requirements are also more demanding. The AHD needs a registered medical practitioner capacity certificate (Section 5), an eligible witness (JP, Commissioner for Declarations, lawyer, or notary), and attorney acceptance if applicable. The Statement of Choices has no equivalent execution requirements: Form A is for a person who can decide about their future health care, while Form B is for a person who no longer has decision-making capacity and is completed by an appropriate substitute decision-maker or person with a close and continuing relationship.
A Direct Comparison
| Feature | Statement of Choices | Advance Health Directive |
|---|---|---|
| Legal status | Advisory — guides clinical decisions | Legally binding when valid and applicable — clinicians must follow |
| Registered medical practitioner certification | Not required | Mandatory (Section 5 capacity certificate) |
| Eligible witness | Not required | Mandatory (JP, Cdec, lawyer, or notary) |
| Can appoint attorney | No | Yes — for health matters |
| Override by doctors | Yes — doctors can make different decisions | A valid and applicable direction has priority; ambiguity or non-applicability may prevent it from governing |
| Covers everyday care | Yes — values, preferences, daily decisions | No — specific treatment instructions only |
| Form A vs Form B | A (with capacity), B (without capacity) | Only created while you have capacity |
| Upload to The Viewer | Yes — via Statewide Office of Advance Care Planning | Yes — via the same process |
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Why You Probably Need Both
The AHD handles the big questions — the life-or-death treatment decisions that need legal force behind them. But it can't cover every medical scenario you'll encounter.
What happens when you develop a urinary tract infection in an aged care home? The AHD probably doesn't address antibiotics for UTIs. Your Statement of Choices, which says you prefer comfort-focused care and want to stay in the facility rather than transfer to hospital, gives the care team practical guidance.
What about pain management preferences? The AHD addresses whether to withhold life-sustaining treatment, but your values about pain relief (maximise comfort even if it affects alertness, vs stay as alert as possible) belong in the Statement of Choices.
What about spiritual care? If you want a chaplain or cultural liaison present during serious illness, that preference belongs in the Statement of Choices. The AHD doesn't cover non-medical aspects of care.
The strongest combination: an AHD that provides legally binding treatment instructions for the critical decisions, paired with a Statement of Choices that guides everyday care decisions and fills in the values context that clinicians need for everything the AHD doesn't specifically address.
How to Complete Both
Statement of Choices Form A — complete this while you can decide about your future health care. There are no AHD-style witnessing requirements. You can complete it with help from an aged care facility's care coordinator, a palliative care nurse, or on your own. Form B is used when the person no longer has decision-making capacity and is completed by an appropriate substitute decision-maker or person with a close and continuing relationship. Submit it to the Statewide Office of Advance Care Planning for upload to The Viewer.
Advance Health Directive Form 4 — requires the full execution process: registered medical practitioner consultation (Section 5 capacity certificate), drafting specific treatment directions, signing before an eligible witness, attorney acceptance, and distribution. The completion time depends on practitioner and witness availability.
Both documents should be submitted to the Statewide Office of Advance Care Planning ([email protected]) for upload to your electronic health record. Both should also be shared with your GP, your local hospital, and anyone you've appointed as an attorney.
Build a Complete Plan, Not Just One Document
Our Queensland Advance Directive & Living Will Kit covers both the Advance Health Directive and the planning framework that wraps around it — including how to structure your treatment directions, how to articulate your values for a Statement of Choices, and how to ensure both documents are properly distributed and accessible when they're needed.
Get Your Free Queensland — Advance Directive Quick-Start
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