Wednesday, 1 August 2018

Medical Treatment Planning and Decision Making

The Medical Treatment Planning and Decision Act 2016 came into force in March 2016. This legislation governs a persons right to access or to refuse medical treatment and helps them to do so even if they subsequently become unable to communicate their wishes.
If a person has decision making capacity and is over the age of 18 years they can make an " advanced care directive" in consultation with their health practitioner. This is a written document which can set out both instructional directives which must be followed and can also set out values directives which are non binding but indicative as to preferences only.
The directive is only referred to once a person loses decision making capacity for their own health care.
Obviously it is critical to be clear and accurate regarding any instructional directives you might wish to include in such a document. For this reason, instructional directives are better prepared in direct consultation with your medical practitioner who will help to ensure that your instructions are clear and easily understood.
An instructional directive might specify that you " ...consent to heart bypass surgery in specified circumstances." or " ..refuses cardiopulmonary resuscitation.
A values directive might specify that you don't want your life prolonged if you can't recognise or communicate with your family or friends.
An advanced care directive:-
1.Must be in English.
2. Must include your full name, date of birth and address.
3. must be signed by the person making it and;
4. Must be witnessed by a registered health practitioner and another adult person who is not the Medical decision maker.
If a child is making a health care directive at least one witness must b a health practitioner with prescribed training and experience.
Those witnessing need to certify that:-
The person signing the directive appeared to have decision making capacity;
The person appeared to sign freely and voluntarily.
The person signed in front of the two witnesses.
The witness is not also the appointed medical decision maker.
The person appeared to understand the nature and effect of the document they were signing.
Obviously such a document is only of value if brought to the attention of those treating the person making such a directive.
To be appointed as a medical treatment decision maker a person must
the be at least 18 years old. Appointments may be limited or very general. No health practitioner is required but one of the witnesses must be a person authorised to take affidavits. The decision maker must sign an acceptance.
Whilst it is possible to appoint more than one medical treatment decision maker, it is only possible to have one person at  a time so second and subsequent decision makers would only come into play if the first or earlier decision makers died or became incapable.
Again, the document will only be of value if it is available to all concerned.

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