Who can be a health care decision maker

Hierarchy of Health Care Decision Makers

People in the hierarchy of health care decision makers are potential health care decision makers, listed in order of priority.

The first two options are appointed under legislation. The remaining options are family or have other connections to the person and must have a close and continuing relationship with the person.

Where there is no other option the Public Guardian has authority to make health care decisions as a last resort.

Determining the most appropriate health care decision maker

The most appropriate health care decision maker is the person on the hierarchy who meets the following criteria at the time the decision is needed (note, this may not be the same person each time a decision is needed):

1. is the option that holds the highest priority under the hierarchy of health care decision makers
2. is an adult, and
3. is 'willing and able' to make the decision.

When there is more than one appropriate health care decision maker on the same level of the hierarchy of health care decision makers such as multiple adult children, the following approach should apply wherever possible:

1. Ask the person who they would prefer to make the health decision for them.
2. Consider how 'close and continuing' the relationships are with the person.
3. Parties could act together.
4. Parties can nominate a health care decision maker amongst themselves, where the chosen party is an option on the hierarchy (delegating responsibility to someone else not listed on the hierarchy is not permitted).

If there is disagreement about the health care decision or nominating a health care decision maker, an application to NTCAT is required to determine the appropriate decision maker. The application must be made by an interested party (including the health care provider).

Refer to our guideline Determining the appropriate health care decision maker PDF (2.2 MB) for more information.

When the person has no one on the hierarchy

The Public Guardian has authority to make health care decisions as a last resort where:

• the person has impaired decision-making capacity for the specific health care decision needed, and
• the person has not made an Advance Consent Decision in an Advance Personal Plan in relation to the health care needed, and
  • there are no identified health care decision makers 'willing and able' to make the decision, or
  • the appointed Guardian or Advanced Personal Plan decision maker is not 'willing and able' to make the decision and an application to NTCAT has not been made, or
  • the Public Guardian is ordered to be the health care decision maker by NTCAT.

Requests to the Public Guardian to make a health care decision in these instances can be made by completing our Health Care Decision Request Form DOCX (114.4 KB) and submitting by email to pgt.health@nt.gov.au.

Before requesting assistance from the Public Guardian, please review our Adult Health Care Consent PDF (3.9 MB) flowchart to ensure you have explored all other options and fulfilled your responsibilities as a health care provider. Specifically, there is the requirement to:

1. Determine the person's capacity to make the specific health care decision needed
2. Check if the person has already made an Advance Consent Decision in an Advance Personal Plan (APP) regarding their current health care needs.
3. If there is no known Advance Consent Decision after reasonable efforts were made to determine this, contact the appropriate health care decision maker for the adult with impaired decision‑making capacity.
4. Determine whether the person is subject to a guardianship order in relation to health care.

Refer to our guidelines Initial responsibilities of a health care provider PDF (1.1 MB) and Determining impaired decision making capacity for a health care decision PDF (1.9 MB) for more information.