Do health professionals understand enduring documents? The case for education

Denise Craig1

1Senior Psychologist, Queensland Health

End of life (EOL) law in Queensland is often not well understood by health professionals, leaving vulnerable people at risk of having their rights and preferences neglected or overruled. Enduring Power of Attorney (EPOA) and Advance Health Directive (AHD) documents are enormously powerful, however this power is futile when not understood or respected by clinicians. When ignored or overruled without acceptable rationale, consumers report feeling a sense of abuse or neglect by the health system. Thus, knowledge of EOL law should be considered requisite knowledge for all health professionals.

With the changing culture of our ageing population and an increased likelihood of informed and outspoken consumers, health professionals are reasonably expected to understand laws which have applied for approximately 20 years in Queensland. Lack of knowledge in this area leads to potential clinical, ethical and legal ramifications for both the individual and organisations.

This study explores health professionals’ understanding of medico-legal aspects of enduring documents before and after one hour of EOL law education in Cairns, Queensland. The study measures: clinician confidence with EPOA/AHD laws; clinician understanding of a person’s right to refuse treatment; legislative hierarchical order for the provision of consent; and the role of health attorneys appointed under an enduring document.

Results suggest critical gaps in clinician knowledge prior to education. Significant improvement is seen after education; however, clinicians continue to hold fixed and firm (unlawful) beliefs.

This pilot study raises concerns that EOL law literacy is likely to be low across Queensland and suggests a case for both mandatory education for health professionals, and for tertiary teaching facilities to incorporate EOL law modules in core content.


Denise is the senior psychologist within the Cairns Memory Service. She is Co-Chair of the Care at End of Life Project (Cairns) and the Qld Statewide Dementia Network. In 2017 she won James Cook University’s College of Health Sciences Outstanding Alumni Award. Having cared for both parents as they faced death, her vocation is to provide assistance, counselling and advocacy with a clear focus on client autonomy, goals and values. Denise is the driving force behind the rollout of End of Life Law education for health professionals in Cairns. She hopes to see similar education become standardised across the State.