Refusal of treatment decisions, Nor for Resuscitation Orders and Power of Attorney

Question 1

What are the schedules under the Medical treatment act 1988 and what do they cover?

Answer 1

Medical Treatment Act 1988 - Schedule 1

~ Patients may complete a ‘refusal of treatment
certificate’ when competent

Medical Treatment Act 1988 - Schedule 2

~ Patients can appoint an agent in advance to make decisions on the pt’s behalf when that patient becomes incompetent

 Schedule 3 - REFUSAL OF TREATMENT CERTIFICATE AGENT OR GUARDIAN of an INCOMPETENT PERSON

Question 2

What does the Medical Treatment Act 1988 - Schedule 2 cover?

Answer 2

~ Patients can appoint an agent in advance to make decisions on the pt’s behalf when that patient becomes incompetent

Question 3

What does the Medical Treatment Act 1988 - Schedule 1 cover?

Answer 3

~ Patients may complete a ‘refusal of treatment

certificate’ when competent

Question 4

The Medical treatment act 1988 refers to medical treatment. define what they mean by ‘medical treatment’.

Answer 4

An operation; the administration of a drug or any other medical procedure.

Question 5

If a patient or family member produces a refusal of treatment certificate. under what circumstances can you still treat them?

Answer 5

• If the refusal of treatment if for a separate condition to what they are now suffering with.

Question 6

In Australia most States have legislation which establish mechanisms for patients to clearly indicate their treatment wishes when they are competent or incompetent. What is the legislation in Victoria?

Answer 6

• Medical Treatment Act 1988

- Guardianship & Administration Act 1986

Question 7

What is the definition of a medical treatment?

Answer 7

An operation; the administration of a drug.. or any other medical procedure.

Question 8

What are the features of the Medical Treatment Act contract?

Answer 8

1. The Act refers to the refusal of ‘medical treatment’
2. A person’s decision to refuse treatment
   may be ‘general’ or ‘specific’
3. There is a limit as to what can be refused
   - a person cannot refuse ‘palliative
   care’ (relief of pain, suffering & discomfort, food &
   water)
4. The refusal only applies to a ‘current
   condition’
5. 2 witnesses required for both schedules
   1 & 2 .
6. The person’s (patient’s) decision is made voluntarily, he/she is informed re the condition & have legal capacity Witnesses must be satisfied that these requirements are made out

Question 9

What are the tree different powers of attorney and what are their powers?

Answer 9

• Power of Attorney - business affairs, only
  operates when the donor has legal capacity i.e.
  is revoked when this is lost
• Enduring Power of Attorney - business affairs –
  operates on specific date or when donor has lost
  capacity
• Enduring Power of Attorney Medical
  Treatment - applies to decisions re ‘medical
  treatment’ - operates only when the donor loses
  legal capacity. (Schedule 2 of the Medical Treatment Act)

Question 10

All of the following points apply to the power of the Enduring Power of Attorney Medical Treatment,
1. The Act refers to the refusal of ‘medical treatment’
2. A person’s decision to refuse treatment
may be ‘general’ or ‘specific’
3. There is a limit as to what can be refused
- a person cannot refuse ‘palliative
care’ (relief of pain, suffering & discomfort, food &
water)
4. The refusal only applies to a ‘current
condition’
5. 2 witnesses required for both schedules
1 & 2 .
6. The person’s (patient’s) decision is made voluntarily, he/she is informed re the condition & have legal capacity Witnesses must be satisfied that these requirements are made out.

There are also another 3 points that apply to Schedule 2 - Enduring Power of Attorney Medical Treatment. What are they?

Answer 10

1. The agent cannot be a witness to the signing of the contract.
2. One of the witnesses must be able to
   witness a statutory declaration
3. Copies of the Schedule 2 appointment
   need to be given to the Senior Medical
   Officer & lodged with VCAT

Question 11

If there is a conflict of interest between the Enduring Power of Attorney Medical Treatment (Schedule 2 MTAct) and the Enduring Guardian (Guardianship and Administration Act), who overrides the others decision?

Answer 11

The Enduring Power of Attorney Medical Treatment overrides the Enduring Guardian decision. Because Enduring Power of Attorney Medical Treatment is specific to medical decisions and takes priority. The Enduring guardian is more like a parent and can make decisions about work accommodation and health care.

Question 12

A legally competent person is always able to accept or refuse treatment

Answer 12

eg Mr Rossiter a competent male quadriplegic (no ability to move) requested his health care professionals to discontinue his hydration & nutrition feeding via his gastrostomy tube
 The court held that provided a medical practitioner provided an explanation of the consequences of ceasing such care, he could refuse the treatment.
 In addition, the health care facility would not be
criminally responsible for any consequences.

Question 13

What happens when there is someone who becomes incompetent and does not have a Enduring Power of Attorney Medical Treatment or a Enduring Guardian?

Answer 13

• where there is no hope of recovery & the
  treatment is futile, treatment may be
  withdrawn (Herrington’s case, 2007 VSC)