Medical Treatment Decision Maker Victoria — Who Decides When a Parent Can't?
When an elderly parent loses the capacity to consent to medical treatment in Victoria, someone else must make those decisions legally. Victoria has a specific statutory framework for this situation. Under the Medical Treatment Planning and Decisions Act 2016, the person who steps in is called the Medical Treatment Decision Maker (MTDM) — and many families discover too late that the person they assumed had authority does not.
How the MTDM Is Determined
Victoria uses a strict hierarchy to identify who becomes the MTDM when a parent cannot make their own medical decisions. The hierarchy applies automatically — you do not need a court order for it to kick in.
The first priority goes to a person the parent appointed while they still had capacity. This can be done using Victoria's appointment of Medical Treatment Decision Maker form, or through an enduring power of attorney for personal matters made before 12 March 2018 under the Powers of Attorney Act 2014. An Advance Care Directive records treatment instructions and values separately.
If the parent did not appoint anyone, the Act's statutory hierarchy applies. The first available and willing person in the hierarchy, with a close and continuing relationship, acts as the MTDM:
- The parent's spouse or domestic partner
- The parent's primary carer (the person who provided the most day-to-day care immediately before the parent lost capacity)
- The parent's adult child (oldest available and willing if there is more than one)
- The parent's parent
- The parent's adult sibling (eldest first)
The key detail families miss: a general Enduring Power of Attorney (Financial) does not grant medical decision-making authority in Victoria. Financial and medical powers are separate instruments. If your parent signed an EPA for finances but not for medical treatment, you may have authority to manage their bank accounts and aged care fees but no legal standing to consent to surgery, refuse treatment, or agree to palliative sedation.
What This Means on the Hospital Ward
The practical impact hits during a hospital admission or aged care transition. When a parent is admitted after a stroke, a fall with head injury, or a sudden cognitive decline, the treating team needs someone to consent to procedures, agree to discharge plans, and sign residential aged care admission paperwork.
If there is no valid medical treatment appointment and the parent lacks capacity, the hospital will apply the statutory hierarchy. This can create problems when siblings disagree about treatment — the oldest adult child may have priority if available, willing, and in a close and continuing relationship. In disputed cases, VCAT (Victorian Civil and Administrative Tribunal) may need to determine the relevant guardianship or medical authority; that does not automatically mean a public guardian is appointed.
What a Medical Treatment Decision Maker Can and Cannot Do
The MTDM can consent to or refuse medical treatment on the parent's behalf. They must make decisions consistent with the parent's known values and preferences — not their own. If the parent wrote an Advance Care Directive expressing treatment preferences, the MTDM is bound by those instructions.
The MTDM cannot consent to special procedures (such as electroconvulsive therapy or non-therapeutic sterilisation) without VCAT approval. They also cannot override an Advance Care Directive that contains binding refusal instructions — for example, if the parent directed that they do not want CPR, the MTDM cannot consent to resuscitation.
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Setting Up the Appointment Before It Is Too Late
The parent must have decision-making capacity at the time they appoint an MTDM. Once capacity is lost, the window closes permanently. This is the critical urgency for families of elderly parents with progressive conditions like dementia — the appointment must happen early, ideally at the same time as setting up the Enduring Power of Attorney (Financial).
In Victoria, use the current Victorian forms and their witnessing requirements. For an Advance Care Directive, the parent signs while they have capacity before two witnesses, one of whom must be a registered medical practitioner; neither witness can be the appointed Medical Treatment Decision Maker.
How This Connects to the Hospital-to-Aged-Care Transition
During a hospital-to-aged-care transition, multiple decisions may require legal authority: agreeing to a discharge plan, signing the residential aged care agreement, agreeing to the residential care contribution structure with Services Australia, and consenting to ongoing medical treatment in the facility.
In Victoria, these decisions are split across different legal instruments. The MTDM handles medical consent. The EPA (Financial) holder handles fees, accommodation deposits, and financial agreements. If different family members hold each appointment — or if no appointments exist — the transition can stall while the hospital waits for legal clarity.
The Hospital to Aged Care transition guide includes a legal authority checklist covering all eight Australian states and territories, helping families identify these gaps before a hospital crisis forces the issue.
Get Your Free Hospital to Aged Care in Australia: Transition Care and Discharge — Quick-Start Checklist
Download the Hospital to Aged Care in Australia: Transition Care and Discharge — Quick-Start Checklist — a printable guide with checklists, scripts, and action plans you can start using today.