Disputes Over Medical Treatment at End-of-Life: Navigating Family Conflict in Queensland

Disclaimer: The following information is for general educational purposes only and does not constitute legal or medical advice. End-of-life treatment disputes in Queensland can involve urgent capacity assessments, QCAT orders, and strict statutory duties for substitute decision-makers. Families, clinicians, and attorneys should obtain personalised guidance from a Queensland solicitor and appropriate medical professionals when conflicts arise.

When a patient in Queensland loses the capacity to make their own medical choices, decisions shift to an Advance Health Directive (AHD), Enduring Power of Attorney (EPA), or the statutory substitute decision-maker hierarchy. Most families reach consensus; some do not. Disagreements over life support, “Do-Not-Resuscitate” orders, or aggressive cancer therapy can escalate rapidly and delay critical care. This article explains:

• Who has legal authority when relatives clash
• The steps clinicians must follow before withholding or withdrawing treatment
• How the Queensland Civil and Administrative Tribunal (QCAT) resolves stalemates
• Practical strategies to prevent conflict or de-escalate once it erupts

Legal Decision-Maker Hierarchy (When the Patient Lacks Capacity)

If two people claim the same priority (e.g., two adult children), clinicians should seek consensus; failing that, they must apply to QCAT for direction.

Common Triggers for Family Conflict

1. Ambiguous or Missing Documents – No AHD or EPA on file; relatives dispute who ranks highest.
2. Divergent Values – One child opposes ventilation for quality-of-life reasons; another insists “do everything possible.”
3. Allegations of Attorney Misconduct – Other siblings accuse the appointed attorney of financial self-interest.
4. Cultural or Religious Expectations – Extended family may expect consultation despite lacking legal status.
5. Urgent Clinical Deterioration – Limited time to decide; emotions run high, communication falters.

“Thirty minutes at the bedside can save thirty days in the tribunal if clinicians verify documents and explain prognosis clearly.”
— Queensland ICU Consultant, 2024 ethics forum

Resolution Pathway for Escalating Disputes

1. Immediate Capacity Check
   Document GCS, orientation, and Qld Capacity Assessment prompts.
2. Locate Governing Documents
   Electronic record scan, family search, solicitor phone-call.
3. Family Meeting with Treating Team
   Explain prognosis, options, likely outcomes; invite questions.
4. Substitute Decision Hierarchy Clarification
   Identify rightful attorney/guardian; confirm they understand duties to reflect patient’s views.
5. Mediation or Ethics Consultation (optional but recommended)
   Hospital’s ethics panel or external mediator reduces adversarial tone.
6. QCAT Application (Urgent Guardianship or Consent Order)
   Guardianship Officer files Form 63; phone hearing within 24–48 hours for life-sustaining measures.
7. Implementation & Documentation
   Once QCAT rules or parties agree, clinicians follow directive; chart decision rationale in detail.

QCAT vs Hospital Mediation

Case Example – Ventilator Withdrawal Dispute

Scenario
Mr Kaur, 78, ventilated after massive stroke. AHD silent on ventilation. EPA appoints eldest son (Raj). Daughter (Simran) insists father would want “every chance.” Raj believes treatment is futile.

Steps Taken

1. ICU team confirms Mr Kaur lacks capacity.
2. Raj produces certified EPA; Simran challenges capacity of EPA (signed one month before stroke).
3. Ethics consult fails to resolve.
4. Hospital lodges urgent QCAT application.
5. QCAT hears evidence (neurologist prognosis, EPA validity) via phone next day.
6. Tribunal upholds EPA, authorises withdrawal in accordance with Raj’s substituted judgment.

Outcome – Treatment withdrawn humanely; Simran accepts ruling after written reasons explain legal hierarchy and clinical futility.

Practical Tips to Prevent or De-escalate Conflict

• Proactive Planning – Encourage patients > 60 years to complete both an AHD and EPA.
• Certified Copies on Admission – Hospitals should request documents at triage, not crisis.
• Clear, Compassionate Communication – Clinicians to use plain language, repeat key points, offer written summaries.
• Cultural Liaison Officers – Engage when English skills or cultural norms differ.
• Objective Capacity Documentation – Detailed notes reduce later allegations of coercion or confusion.

Frequently Asked Questions

Q: Can a statutory health attorney override a valid EPA?
A: No. An attorney under an EPA outranks statutory attorneys unless QCAT suspends or revokes the EPA for misconduct.

Q: What if an AHD conflicts with family wishes?
A: The AHD controls if clinically relevant and valid; clinicians must follow it, even over family objections.

Q: How long does an interim guardianship order last?
A: Up to 3 months (Guardianship Act s 129), after which a full hearing reviews the appointment.

Q: Can multiple attorneys act jointly on health decisions?
A: Yes—if the EPA specifies “joint” authority. Deadlock may require QCAT intervention.

Q: Is hospital mediation confidential?
A: Generally yes—notes are not disclosed to courts unless all parties consent.

Key Takeaways

• Hierarchy matters: AHD → QCAT Guardian → EPA Attorney → Statutory Health Attorney → Public Guardian.
• Capacity documentation and swift location of directives prevent many disputes.
• QCAT provides rapid, binding rulings when families cannot agree or misconduct is alleged.
• Early conversations, certified documents, and empathetic communication remain the most effective tools to honour patient wishes and avoid courtroom conflict.

Sources / Citations

1. Powers of Attorney Act 1998 (Qld) — ss 31, 41-45, 63-66
2. Guardianship and Administration Act 2000 (Qld) — ss 80-86, 129
3. Queensland Capacity Assessment Guidelines 2020 (Queensland Health)
4. Hospital and Health Boards Act 2011 (Qld) — s 142
5. Re JRR [2022] QCAT 314 — urgent guardianship for ventilation dispute