Refusal of Treatment Certificate Agent or Guardian of Incompetent Person

The requirements for refusing medical treatment depend on whether or not the patient has the ability to make their own decision and is able to consent to medical treatment.

A person appointed as a medical agent under an enduring power of attorney (medical treatment) or a guardian appointed by the Victorian Civil and Administrative Tribunal (VCAT) with medical treatment decision-making powers can refuse medical treatment on behalf of a patient who cannot consent.

To do this, the medical agent or guardian must sign and have witnessed a ‘Refusal of Treatment Certificate: Agent or Guardian of Incompetent Person’ form (right menu). They specify the type of treatment they wish to refuse. No doctor can provide the treatment that has been specifically refused in the certificate.

To sign, a medical agent or guardian must:

  • have been given sufficient information about the patient’s condition
  • understand this information
  • understand what they are doing by signing the certificate
  • make the decision voluntarily (advice can be given, but they must not be coerced)
  • hold the view that either the medical treatment would cause the patient unreasonable distress, or there are reasonable grounds for believing the patient would, if competent and after serious consideration, have considered the treatment unwarranted.


Anyone who has a genuine interest in the patient’s welfare can ask VCAT to consider the actions of the medical agent or guardian. VCAT can suspend or cancel an enduring power of attorney (medical treatment) if the medical agent is not acting in the patient’s best interests or cancel a guardianship order if a guardian is not acting in the patient’s best interests.

If this happens, then any certificate signed by the medical agent or guardian is also cancelled. VCAT sends a written notice confirming this to the hospital or nursing home.

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