Dying to Discuss

Who decides when family members disagree about end-of-life care?

Australia · 29 August 2026 · 4 min read · Reviewed by Dr Kane Treble

When family members disagree, the decision-maker is not automatically the loudest person, the closest relative in a social sense, or a family vote.

General information: This page gives general information for people in Australia. It cannot give legal advice or decide who has authority in one person's situation. End-of-life law differs between states and territories. Confirm current rules with the treating health service, the relevant state or territory public guardian or advocate, or a lawyer.

When family members disagree, the decision-maker is not automatically the loudest person, the closest relative in a social sense, or a family vote. If the person can make the decision, they decide. If they cannot, the decision is usually guided by any valid advance care directive and then by the legally authorised substitute decision-maker under the law of that state or territory.

Doctors also have their own duties. They must offer treatment that is clinically appropriate, explain options, provide comfort care, and avoid treatment that is not medically beneficial.

If the person can decide

An adult is presumed to have decision-making capacity unless there is evidence they do not. Capacity is decision-specific. A person may be able to decide one thing and not another. They may also be able to decide with support, such as more time, an interpreter, communication aids, hearing aids, glasses or a quieter room.

An adult with capacity can refuse treatment, even life-sustaining treatment, and even if family members disagree. They can also choose who they want involved in conversations.

If the person cannot decide

The team should look for any advance care directive or similar document. The name and legal effect of these documents differs across Australia. Some directives can refuse treatment in advance. Some record values and preferences. Some appoint a person to decide.

If there is no valid directive that answers the decision, the team must identify the substitute decision-maker. This may be an appointed guardian, medical treatment decision-maker, enduring guardian, attorney, spouse, unpaid carer, close friend or relative, depending on the state or territory and the document in place.

The substitute decision-maker should not decide based on what they personally want. They should use the person's known wishes, values and preferences as far as the law allows. In some places this is called substituted judgement. In others, the law also uses best interests or welfare language.

If no agreement can be reached

Ask for a family meeting with the senior doctor and nurse. Ask the hospital or aged care home whether it has a clinical ethics service, conflict resolution process or patient liaison service.

If the dispute continues, the treating team or family may seek advice from a public guardian, public advocate, civil and administrative tribunal or court. This is uncommon, but it can happen when the decision is urgent, serious or unresolved.

When to get help now

Get urgent help if a decision is needed now and no one knows who has authority, if the person is in pain or distress while people argue, or if family conflict is making care unsafe.

Call 000 if anyone is in immediate danger. In hospital, ask for the nurse in charge, treating consultant, after-hours manager or social worker. In aged care, ask for the registered nurse in charge and the person's GP or palliative care service.

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