LWS101 Chap.10 Withholding or Withdrawing Treatment
Withholding or Withdrawing Treatment
When not treating is lawful
Health professionals can have a duty to provide life-sustaining treatment, yet in some circumstances withholding or withdrawing it is lawful.
A capable adult may refuse any treatment, because autonomy overrides the sanctity of life.
After capacity is lost
Bland's case recognised that withdrawal may be in a person's best interests, and Queensland's Powers of Attorney Act 1998 and Guardianship and Administration Act 2000 permit it in certain circumstances, through an advance health directive, a substitute decision-maker or the Tribunal.
Conflict at the bedside
The End of Life Law for Clinicians modules include managing conflict and futile or non-beneficial treatment, two themes that often appear together in scenarios.
When family members disagree with a directive or with a team's plan, the nurse's role is to support them, make sure the lawful decision-maker and any directive are known, document the disagreement and escalate rather than resolve it alone.
What this chapter covers
- 01
Duty to Provide Treatment
- 02
Capable Refusal
- 03
Bland's Case and Best Interests
- 04
Advance Health Directives
- 05
Substitute Decision-Makers and the Tribunal
- 06
Nursing Care When Treatment Stops
Worked example · free
A directive versus a distressed family
- 1A directive the woman made while capable carries her refusal forward now that she cannot decide.
- 1The husband's wish does not override a valid directive, although his views deserve a hearing and support.
- 1The nurse should make sure the directive is known to the team, document it and escalate the conflict.
Key terms
- Life-Sustaining Treatment
- Treatment needed to keep a person alive, such as ventilation, dialysis or artificial nutrition.
- Best Interests
- The common law test, recognised in Bland's case, under which withdrawing treatment from a person without capacity may be lawful.
- The Tribunal
- The Queensland body that can make decisions for adults with impaired capacity, including about life-sustaining treatment.
- Advance Care Planning
- Planning ahead for future care decisions while a person can still make them, which Principle 3.6 asks nurses to facilitate.
- Withdrawal of Treatment
- Stopping a treatment that has already started, such as dialysis or ventilation, as distinct from withholding one that has not begun.
- Comfort Care
- Care focused on relieving pain and distress that continues after a life-sustaining treatment is stopped or not started.
Withholding or Withdrawing Treatment FAQ
Can a substitute decision-maker refuse life-sustaining treatment?
Yes, in certain circumstances. The Week 10 overview explains that the Powers of Attorney Act 1998 and the Guardianship and Administration Act 2000 permit withdrawal where an adult lacks capacity, and the decision-maker must apply the guardianship principles, including what the adult would likely have wanted.
What did Bland's case decide?
In Airedale NHS Trust v Bland, decided in 1993, the court accepted at common law that stopping or not starting life-sustaining treatment for a patient without capacity may be in that patient's best interests. The Week 10 overview cites it as the starting point for lawful withdrawal.
Does care stop when treatment is withdrawn?
No. Principle 3.6 asks nurses to ensure relief from distress, respect cultural practices around death, facilitate advance care planning and support families even when the outcome they want cannot be delivered. Comfort care and family support remain the nurse's work.
What if the family disagrees with the patient's advance health directive?
A valid directive made while the person had capacity carries their decision forward after capacity is lost, so family disagreement does not override it. The nurse should listen to and support the family, make sure the treating team knows about the directive, document the conflict and escalate it so that it can be resolved properly.
Exam move
Build a decision table with five rows: the capable adult, a directive, a substitute decision-maker, the Tribunal and the common law, and learn the legal effect of each. For every scenario, find the decisive fact first: capacity, a directive, or who has authority. Pair each law heading with an implementation heading that names comfort care, documentation and family support, so your answer never ends at the decision itself.
Prepare a short script for supporting a family through disagreement, because it gives you a ready implementation step. Revisit the Week 5 rules on substitute decision-makers alongside this chapter, since the overview relies on them for every adult without a directive.
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