Who Makes Medical Decisions If Your Advance Care Directive Is Unclear?

An Advance Care Directive is meant to make your future healthcare wishes clearer.

But sometimes the document does not answer every question.

It may be too general.

It may not cover the situation doctors are dealing with.

Or family members may disagree about what the wording means.

That is why many families ask: who makes medical decisions if your Advance Care Directive is unclear?

The answer depends on your situation, your state or territory, your appointed decision-maker, and the healthcare decision being made.

In many cases, doctors will look at your directive, speak with your substitute decision-maker, and consider what is known about your wishes, values and best interests.

Why An Advance Care Directive May Be Unclear

An Advance Care Directive may become unclear for several reasons.

Sometimes the wording is too broad.

For example, a person may write that they do not want “unnecessary treatment”.

That may sound clear at home.

But in hospital, doctors may need to know what that means in a specific medical situation.

Does it mean no surgery?

No intensive care?

No CPR?

No feeding tube?

Or something else?

Other times, the directive may have been written many years ago and no longer match the person’s current health circumstances.

Who Is Usually Involved In The Decision?

No single person automatically takes complete control of every situation.

Healthcare decisions often involve a combination of medical advice, legal requirements, substitute decision-makers and the person’s known wishes.

If your Advance Care Directive is unclear, healthcare professionals will usually try to understand your wishes as best they can.

The people involved may include:

your treating doctors
your substitute decision-maker
your spouse or partner
adult children or close family
your GP
hospital staff
aged care providers, if relevant

The exact process depends on the laws and healthcare procedures in your state or territory.

The goal is usually to work out what decision best reflects your wishes and values.

Your Substitute Decision-Maker May Be Asked

If you have appointed a substitute decision-maker, they may be asked to help make or guide medical decisions.

This person may have a different title depending on where you live.

They may be called an Enduring Guardian, medical treatment decision-maker, substitute decision-maker, attorney for health matters, or another recognised name.

Their role is not simply to choose what they personally want.

Their role is usually to consider what you would have wanted, based on your values, preferences and any written instructions.

This is why choosing the right person is so important.

Doctors Will Consider The Medical Situation

Doctors and healthcare teams also play an important role.

They need to consider the actual medical situation in front of them.

They may look at:

your diagnosis
your likely outcome
available treatment options
risks and benefits of treatment
whether the directive applies to the situation
whether your wishes are clear enough to guide the decision

If the directive clearly refuses a particular treatment and applies to the situation, it may carry strong weight.

If the wording is general or does not clearly apply, doctors may need input from your substitute decision-maker or family.

What If Family Members Disagree?

Family disagreement can make an unclear directive even more stressful.

One person may believe you would want treatment continued.

Another may believe you would prefer comfort care.

Both may be acting out of love.

But without clear guidance, the situation can become emotionally difficult.

Healthcare teams may try to bring the family together, explain the medical situation, and focus the discussion on what the person would have wanted.

If disagreement continues, the matter may need to follow local hospital, legal or tribunal processes.

Can An Unclear Advance Care Directive Cause Delays?

Sometimes yes.

If healthcare providers, substitute decision-makers or family members are unsure what the document means, additional discussions may be needed before treatment decisions can be made.

In urgent situations, healthcare teams may need to spend time clarifying the person’s wishes before moving forward.

Clear wording and regular reviews can help reduce the risk of confusion during stressful situations.

What If There Is No Appointed Decision-Maker?

If you have not appointed a substitute decision-maker, the law in your state or territory may determine who can make healthcare decisions for you.

This is often based on a recognised order of people close to you.

That may include a spouse, partner, unpaid carer, close family member or another person recognised under local law.

The rules are not the same everywhere in Australia.

This is one reason it is helpful to appoint the right person clearly while you still have capacity.

Can Doctors Ignore An Advance Care Directive If It Is Unclear?

Doctors should not simply ignore your Advance Care Directive.

Even if it is unclear, it may still provide useful information about your values and wishes.

However, if the directive does not clearly apply to the medical situation, healthcare providers may need to interpret it carefully.

They may also need to rely on your substitute decision-maker, your known preferences, clinical judgement and local legal requirements.

Why Clear Wording Matters

Clear wording helps reduce pressure on everyone.

It helps doctors understand your wishes.

It helps your substitute decision-maker speak with more confidence.

It helps family members avoid guessing.

An Advance Care Directive does not need to predict every possible future medical event.

But it should be clear enough to guide people when decisions are difficult.

Reviewing Your Directive Can Reduce Confusion

Regular reviews can help prevent uncertainty later.

A review may be useful if:

your health changes
you receive a serious diagnosis
you move interstate
your family situation changes
your decision-maker changes
your treatment preferences change
your document is old or vague

A review does not always mean rewriting everything.

Sometimes it simply confirms that the document still reflects your wishes.

What Families Can Do If The Directive Is Unclear

If a directive is unclear during a medical situation, families should try to stay focused on the person’s wishes.

This is not the time for personal arguments or old family disagreements.

Helpful questions may include:

What did the person say mattered most to them?
Did they ever talk about quality of life?
Did they express views about hospital care or life support?
Who did they trust to speak for them?
Is there a newer version of the document?

These questions may help guide the discussion, but they do not replace proper medical or legal advice.

Common Mistakes To Avoid

Using Vague Wording

Broad phrases can be hard to apply during real medical decisions.

Not Appointing A Decision-Maker

If no one is appointed, the law may decide who has authority.

Not Talking To Family

Family members may struggle if they have never heard your wishes directly.

Leaving Old Versions Around

Different versions can create confusion about what you currently want.

Assuming Doctors Will Know What You Mean

Doctors can only work with the information available to them.

Real-Life Example

Joan completed an Advance Care Directive several years ago.

In it, she wrote that she did not want “heroic measures”.

Years later, Joan was admitted to hospital after a serious stroke.

Her family and doctors needed to make urgent decisions about treatment.

The phrase “heroic measures” was not clear enough by itself.

Joan’s appointed decision-maker spoke with the doctors and explained Joan’s past conversations about quality of life, independence and comfort.

That helped the healthcare team better understand what Joan was likely to have wanted.

The directive still mattered, but the conversations around it helped make the decision clearer.

Frequently Asked Questions

Who makes medical decisions if my Advance Care Directive is unclear?

Your substitute decision-maker may be involved, along with doctors and healthcare professionals. The exact process depends on your state or territory.

Can family members decide what happens?

Family may be involved, especially if they are recognised under local law or know your wishes. But they cannot simply ignore your directive because they disagree with it.

What if I have not appointed a substitute decision-maker?

The law in your state or territory may set out who can make decisions. This is usually someone close to you, but the rules vary.

Can doctors ignore unclear instructions?

Doctors should still consider the directive, but unclear instructions may need to be interpreted with help from your decision-maker, family and local legal requirements.

How can I reduce the risk of confusion?

Use clear wording, review the document regularly, appoint the right decision-maker and talk to your family about your wishes.

Should I update a vague Advance Care Directive?

If your directive is vague, old or no longer reflects your wishes, it is sensible to review it and check the process for updating it in your state or territory.

Sources

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Disclaimer

This article provides general information only. It is not legal, medical or financial advice. Advance Care Directive laws, substitute decision-making rules and healthcare processes vary across Australian states and territories. Always check the rules in your location and seek professional advice for your personal situation.