Consent to withhold or withdraw life-sustaining measures
A life-sustaining measure is a proposed medical treatment that can save a person’s life. This may include interventions such as:
- cardiopulmonary resuscitation (CPR)
- artificial nutrition and hydration.
Life-sustaining medical measures can only be withheld or withdrawn where consent is obtained or where legal authority is given to make the decision without consent. Where the patient lacks capacity to make healthcare decisions, except in some acute emergency situations, consent is required before any life-sustaining treatment can be withheld or withdrawn.
Consent must be obtained through the following (in order):
- the patient's valid advance health directive
- a guardian appointed by the Queensland Civil and Administrative Tribunal
- a health attorney under an advance health directive or enduring power of attorney
- a statutory health attorney/s
- the Public Guardian.
Because the need for CPR is considered an acute emergency, consent is not required—provided the medical officer is not aware the patient has objected to the withholding of CPR. Consent is always required to withhold or withdraw artificial nutrition and/or hydration, even in an acute emergency.
The ARP form does not strictly provide consent like an advance health directive as it is not a legal document given a particular status under legislation. Instead, it documents the patient's wishes to withhold medical treatment.
Read Queensland Health Guidelines about:
- informed decision-making in healthcare
- decision-making for withholding and withdrawing life-sustaining measures from adult patients
An ARP does not replace an advance health directive.
The ARP form is a clinical tool completed in a hospital setting (including in a residential aged care facility) by a medical officer.
An advance health directive is a legal document given particular status by legislation, prepared by a person, that allows them to plan what medical treatment and healthcare they would like in the event they cannot make decisions for themselves.
Sometimes a patient will have both documents. If a patient has a valid advance health directive, this should be noted on page two of the ARP form.
If the patient has both forms and the advance health directive gives directions about resuscitation—and the patient does not have capacity to make decisions—then the advance health directive should be followed
The only exceptions would be where the directions in the advance health directive are considered inconsistent with good medical practice, or where circumstances have changed so that the directions are inappropriate.
If a patient arrests and does not have an ARP or advance health directive, clinicians should act in accordance with good medical practice for that patient, subject to any known objections of the patient while the patient had capacity.
Sometimes cardiopulmonary resuscitation (CPR) is not medically appropriate, regardless of any previously held wishes, discussions or documentation.
Legally, no one can insist on medical treatment that would not meet the standards of good medical practice.
Despite this, sometimes a patient, substitute decision-maker or family member may feel strongly about wanting everything possible to be done, but a medical officer may determine that CPR may cause the patient harm, and offer them limited or no benefit.
The situation can be even more complicated if:
- a patient has impaired capacity
- they do not have an advance health directive
- the patient has an advance health directive, but the direction the patient has given is expressed in a way that is uncertain or may not apply in the current set of circumstances
- there is a substitute decision-maker(s) demanding resuscitation.
In all situations like this, clinicians are required to make all efforts to communicate to the patient, their decision-maker(s) and their family to help them understand:
- the patient's condition and prognosis
- the reasons for the clinical recommendation
- why it is in the patient's best interests.
It may be helpful to involve social work staff, or other staff with whom the family have formed a relationship with.
Substitute decision-makers also have responsibilities under the guardianship legislation to act in the patient's best interests. If a medical officer or any other clinician does not believe a substitute decision-maker(s) is acting in a patient's best interests, the matter should be referred to the Office of the Public Guardian if a satisfactory solution cannot be found.
The information provided on these pages is general in nature and is not intended as legal advice. Resuscitation planning issues will often be complex—you need to consider individual circumstances, and sometimes the level of detail and extra information required will mean you need to seek more advice. If you are in any doubt please get legal advice.
Read information about legal considerations, targeted towards patients, carers and families. It covers:
- Substitute decision-makers
Find advance care planning information for patients.