Experts call for reform of living wills | Health Beauty Online ...

Hot topics:australia, sport, government-and-politics, nsw, law-crime-and-justice, community-and-society, disasters-and-accidents, states-and-territories, wa, united-states

There are growing calls to change the law around living wills, or advance care directives, that allow people to set out their wishes for end of life care in advance.

As people near death, many lose the ability to communicate, and senior legal officers in New South Wales and Victoria say reform is sorely needed at a state and national level.

Victorias former public advocate, Julian Gardner, says the current law is so complex that doctors may not follow a patients wishes to stop life-prolonging treatment.

Many doctors have a muddled understanding of what the law is and are often guided by their ethical principles of preserving life were possible, of curing where possible, he said.

I think sometimes that their concept of? clinical best interests can override what somebody would have wanted.

There are other reasons doctors are not respecting end of life wishes.

They include hospitals being geared up to resuscitate not palliate, big advances in life-saving technology and doctors not wanting to make the difficult decision of when to move from life-prolonging treatment to palliative care.

A new National Framework on Advance Care Directives is due to be released. It wants to harmonise different laws in each state and territory.

Listen to Di Martins full report on Background Briefing at 9am on Sunday

Mr Gardner says those different laws are not consistent, which is a big problem in a mobile society.

He gives the example of a Victorian who has a stroke while holidaying in Queensland.

They have a different set of documentation there, and whilst you can sign a directive in Queensland, a doctor can override that if they believe its in good medical practice, he said.

So particularly given the difficulties that doctors have recognising and understanding their omedical willswn state laws, confronted with a document from another state, they may well say, Oh, I dont feel as though I know enough about this and therefore I am going to treat.

He says Victorian law is also confused.

In Victoria we have got three different pieces of legislation, and possibly four, that deal with medical law. It is scattered around, he said.

If you want to find the definition of emergency medical treatment for which you dont need consent, you go to the Guardianship and Administration Act ? not where one would think to look.

Mr Gardner says while confusion persists, law reform is difficult.

I had discussions with more than one health minister who personally expressed support for what I was talking about but were unwilling to take it to Cabinet, he said.

I think this was simply because of this concern that this would raise the spectre of the euthanasia debate. Political parties are unwilling to have that debate.

In NSW the immediate past president of the Guardianship Tribunal is also calling for law reform.

Di Robinson says as well as writing down your wishes in an advance directive, you can appoint someone to ensure your wishes are carried out. These substitute decisions makers have different names in different states.

In NSW they are called enduring guardians.

In her first interview since stepping down, Di Robinson told Radio Nationals Background Briefing program that doctors do not know whether to follow a directive, or a guardian.

Say for example I have appointed my son is my enduring guardian and I have given him that medical power. But I have also made an advance care directive, she said.

And when something happens to me ? I might have a stroke, or a brain injury or I develop dementia over time ? the doctor has to look at my advance care directive and decide what sort of treatment I am endorsing, I am consenting to.

And what if my son by this stage disagrees with that? Maybe Ive said no I dont want active treatment. And he says no I want her to have all of the treatment that is available. What does the doctor do?

Ms Robinson says there are other problems in NSW, including the raft of different advance directive forms available, and confusion about whether they need to be signed, or witnessed.

She says the NSW Law Reform Commission should get involved.

The legal mechanisms are confused and overly complex. And they need to be clarified. We need some clarity about the standing and status of advanced care directives, she said.

We have got no clear forms, no witnessing professions, no registers, we dont know who has made these documents.

I think that there is considerable confusion both in the general community and particularly in the medical community about how these documents operate, particularly in the circumstances of conflict or difficulty.

Mr Gardner is concerned that politicians often avoid debates about advance care directives.

He says that directives are sometimes associated with euthanasia.

I think a lot of people are confused about this? people get very worried about refusing treatment or withholding treatment, he said.

Treatment is never withheld. You will always have treatment even if that treatment is palliative care treatment. But people skip over the kind of distinction and therefore many peoples minds it becomes blurred.

Tags: federal-state-issues, states-and-territories, health, diseases-and-disorders, doctors-and-medical-professionals, health-ethics, older-people, health-policy, australia, nsw, vic

First posted

Exclusive: Federal Health Minister Nicola Roxon has been caught out seeking financial support from one of the nations top cigarette makers.

The ABCs Ben Worsley speaks to residents after a tornado swept through the NSW town of Red Rock, whipping up cyclone-force winds and damaging homes.

Frustrated airline passengers from Tasmania speak about having to board the Spirit of Tasmania ferry to get to Melbourne.

ABC correspondent Lisa Millar says Republican presidential candidate Mitt Romney has used a debate to attack president Barack Obama.

The ABC News Online Investigative Unit encourages whistleblowers, and others with access to information they believe should be revealed for the public good, to contact us.

Former child migrants from the UK lodge claims against the NSW and Federal governments and the charity responsible for their care.

This service may include material from Agence France-Presse (AFP), APTN, Reuters, AAP, CNN and the BBC World Service which is copyright and cannot be reproduced.

Random Posts

Source: http://healthbeauty.cc/experts-call-for-reform-of-living-wills/

endeavour wtf shuttle launch coast to coast joakim noah come fly with me brain games