Advance health directive (Form 4)

By an advance health directive, an adult (the principal) can give directions about their future health care and special health care, give information about those directions, and appoint one or more eligible attorneys for health matters in case the directions prove inadequate (s 35, Powers of Attorney Act 1998 (Qld)). An advance health directive must be in writing and may use the approved form (s 44(2)). Form 4 is that form, Version 5, approved for use from 30 November 2020. A direction only operates while the principal has impaired capacity for the matter it covers (s 36(1)). The directive must include a certificate from a doctor or nurse practitioner that the principal appeared to have capacity to make it (s 44(6)).

When you need it

• You want to record your wishes about future medical treatment in case you cannot make or communicate decisions yourself.
• You want to give directions about life-sustaining treatment, such as CPR, assisted ventilation, artificial nutrition and hydration, or antibiotics, near the end of life.
• You want to appoint an attorney for health matters only. You can do this in section 6 of the form, or rely on an attorney already appointed in an enduring power of attorney.
• For financial matters you need an enduring power of attorney (Form 2 or Form 3). An advance health directive covers health matters only.

1. 1

   Sections 1 to 3: you and your values

   Give your name, date of birth and address, then your major health conditions and concerns. Section 3 is optional and records what matters to you, what worries you, your cultural or spiritual values, what would comfort you near death, and who should or should not be involved in discussions. These are not directions.

2. 2

   Section 4: your directions

   Discuss this section with your doctor first. For life-sustaining treatment, choose one of four options: consent to all, refuse all, leave the decision to your attorneys, or give specific directions treatment by treatment. Then add any directions about other health care and about blood transfusions.

3. 3

   Section 5: doctor or nurse practitioner certificate

   The form's certificate is printed for a doctor, but section 44(6) of the Act also allows a nurse practitioner to sign it, and section 180 confirms that this applies even though the approved form does not mention nurse practitioners. They certify that they discussed the directive with you and that you appeared to have capacity. They must not be your witness, the person signing for you, your attorney, a relation of you or your attorney, or a beneficiary under your will (s 44(7)).

4. 4

   Section 6: appoint health attorneys (optional)

   Name each attorney and say how they must decide if there is more than one, otherwise they act jointly. Add any terms or instructions. Attorneys must be eligible: at least 18, with capacity, not your paid carer or health provider, and not a service provider for a residential service where you live (s 29(2)).

5. 5

   Section 7: sign in front of an eligible witness

   Sign in front of a justice of the peace, commissioner for declarations, lawyer or notary public who is not the person signing for you, your attorney, a relation of you or your attorney, your paid carer or health provider, or a beneficiary under your will (s 31). The witness checks section 5 has been signed and dated, completes the witness certificate, states the number of pages and signs both pages. If you cannot sign, an eligible signer can sign at your direction.

6. 6

   Section 8: attorneys accept

   If you appointed attorneys, each signs the acceptance on the original after you and the witness have signed section 7. An attorney cannot act until they have accepted (s 44(8)).

• You do not lodge or register an advance health directive anywhere. Keep the original in a safe place.
• Give certified copies to your attorneys, doctor and other health providers, and tell close family and friends where to find it. The Queensland Government guidance also suggests giving a copy to your local hospital.
• You can send a copy to Queensland Health's Office of Advance Care Planning so it is available to authorised clinicians, or upload it to My Health Record. It is valid either way.
• A copy can be certified as a true and complete copy by a justice of the peace, commissioner for declarations, lawyer or notary public, among others (s 45).

• Read the Form 10 explanatory guide alongside the form. Each section refers to its pages.
• A direction to withhold or withdraw life-sustaining treatment only operates in the circumstances set out in section 36(2), for example a terminal illness where death is expected within a year, permanent unconsciousness or a persistent vegetative state.
• Health providers do not have to follow directions that are uncertain, inconsistent with good medical practice, or overtaken by changed circumstances, so write clear directions and review them at least every two years or if your health changes significantly.
• You can revoke a direction in writing at any time you have capacity, and tell your attorneys. A later directive revokes an earlier one to the extent they are inconsistent.