Requesting a healthcare decision
We work with healthcare providers to make decisions about medical treatments and procedures for adults with impaired decision-making ability (also referred to as impaired capacity).
Our role includes providing or refusing consent for treatments and, in some cases, overruling other decision-makers to protect the patient’s rights and wellbeing.
Who can request the public guardian’s consent for health care?
You can request our consent for medical treatments and procedures for adults with impaired decision-making ability if you're:
- A healthcare provider, or
- Someone acting under their supervision.
Note
Only the treating healthcare provider, or someone acting under their supervision, can request health care consent.
When can we provide health care consent?
Under Section 66 of the Guardianship and Administration Act 2000, there is a set order of priority for obtaining health care consent:
- Advance health directive (AHD)
If your patient has an AHD, you must follow their instructions regarding treatment or the withholding or withdrawing of life-sustaining measures. - Guardian
A guardian when formally appointed by the Queensland Civil and Administrative Tribunal (QCAT) for health care decisions. - Attorney
An attorney for personal matters appointed under an Enduring power of attorney (EPOA) or AHD. - Statutory health attorney (SHA)
If none of these options applies, the patient’s SHA can provide consent.
We may provide consent in the following circumstances:
- As the person’s guardian appointed by QCAT for health care decisions
- As their attorney under an EPOA or AHD
- As the SHA of last resort, but only if no one else is available and appropriate to act in this role.
Important:
If a formally appointed guardian or attorney cannot be contacted or located, we cannot act as the SHA. In this situation, you must consider other options, including whether the specific healthcare decision requires legal consent under the Act.
Before requesting us to act as the SHA of last resort, please ensure you've made all reasonable efforts to contact an appropriate decision-maker in the person’s life.
We cannot provide health care consent for individuals under 18 years of age.
What types of health care can we consent to?
We can provide or refuse consent for most medical and dental treatments unless your patient has objected to it in their AHD. This includes:
- Surgery
- Endoscopy or colonoscopy
- Pap smears
- Dental procedures, such as fillings or teeth removal
- Withholding or withdrawal of life-sustaining treatment (unless consent is not required - see below).
When is health care consent not required?
You can carry out certain health care without our consent, including:
- Urgent health care: to save your patient’s life or prevent significant pain or distress
- Withholding or withdrawal of life-sustaining treatment in an emergency: if the decision must be made immediately, aligns with good medical practice and there are no objections
- Minor and uncontroversial health care: for example, administering a prescribed antibiotic or giving a tetanus injection. It’s your responsibility to determine whether the treatment fits this description.
- Hospital admissions and transfers.
Can life sustaining treatment be withheld or withdrawn without consent?
We operate within a legislated framework when making decisions about withholding or withdrawing life-sustaining treatment for adults with impaired decision-making ability.
Life-sustaining treatment refers to medical interventions essential to sustain or prolong life, such as cardiopulmonary resuscitation (CPR), assisted ventilation, and artificial nutrition and hydration.
In non-emergency situations
- Approval from a senior officer or senior executive at OPG is required before life-sustaining treatment can be withheld or withdrawn.
- You're strongly encouraged to start the consent process during our phone line operating hours to avoid delays.
In emergency situations
The Guardianship and Administration Act 2000 permits you to withhold or withdraw life-sustaining measures without consent if:
- The adult has impaired decision-making ability for the relevant health matter, and
- Continuing or starting the treatment would not align with good medical practice.
Such decisions must be made immediately and adhere to good medical practice. However, life-sustaining measures cannot be withheld or withdrawn without consent if the adult is known to object.
When can a patient’s objection be overridden?
We can consent to health care despite your patient’s objection if the:
- patient has minimal or no understanding of what the health care involves or why it's required
- health care is likely to cause either:
- No distress, or
- Temporary distress that's outweighed by the benefit to the patient.
It’s your responsibility to assess whether your patient’s objection should be overridden. If you request our consent in such cases, we'll carefully weigh these factors against the patient’s human rights before making a decision.
What health care decisions can we not consent to?
We cannot consent to ‘special health care’, including:
- Removal of tissue for donation
- Sterilisation
- Termination of a pregnancy
- Special medical research or experimental health care.
Only QCAT or the Supreme Court can consent to these treatments. QCAT may appoint us to represent a patient’s views, wishes and preferences during their decision-making process.
What information do we need to make a decision?
When requesting our consent, you’ll need to provide:
- Your name, contact details and confirmation that you are the treating practitioner or part of the treating team
- Your patient’s full name and date of birth
- Whether your patient is an OPG client
- Who you've already contacted to seek consent
- Your patient’s medical condition
- Details of the proposed treatment or procedure
- The date and time of the procedure
- The benefits, risks, and potential side effects
- Whether anaesthetic is required
- Whether you’ve discussed the treatment with the patient
- Whether the patient objects to the treatment.
By providing this information promptly, you’ll help us make a timely decision.
For withholding or withdrawing life-sustaining treatment, we’ll also need:
- Your patient’s prognosis, including their chance of recovery
- Whether the decision aligns with good medical practice
- Any wishes your patient, or their close contacts have expressed about their treatment
- Whether the patient has advance care planning documents (e.g., an Advance health directive)
- Proposed palliative care measures
- Whether a second opinion has been obtained and, if so, from whom.
Other stakeholders, such as family members, are welcome to provide us with additional information to support the decision-making process.
How long does it take us to make a decision?
The time required depends on the complexity of the situation. We aim to decide within 24 hours, but this may be extended by factors such as family conflict or the need for additional consultations.
We understand health care decisions are often time-critical, so we strive to act as quickly as possible.
Can we overrule another decision-maker?
Yes, we can overrule a substitute decision-maker’s refusal of treatment if it’s inconsistent with the health care principles outlined in the Guardianship and Administration Act 2000.
To request this, email publicguardian@publicguardian.qld.gov.au with details of the situation.
Before we make a decision, we’ll consider the substitute decision-maker’s explanation, your medical expertise and the law.
How do you request consent from us?
You can request consent by:
- calling us on 1300 753 624 (9am–5pm, 7 days a week, including public holidays).
- leaving a voice message or sending us an email if calling outside these hours. Please provide your name and contact details, your patient’s full name, date of birth and proposed treatment. We’ll respond as soon as possible.