Victorian aged and disability providers and the Medical Treatment - - PowerPoint PPT Presentation

Victorian aged and disability providers and the Medical Treatment Planning and Decisions Act 2016

Sonia Gardiner

Senior Medical Treatment Decision Officer

Acknowledgement of Country

I acknowledge the Traditional Owners of the land on which we are meeting. And I pay my respect to Elders, past and present and extend that respect to other Aboriginal people present.

About this presentation

♦ overview of the MTPD Act ♦ ‘advance care directive’ ♦ ‘medical treatment decision maker’ ♦ ‘medical treatment’ ♦ prescription pharmaceuticals ♦ the process(es) for

• btaining

a medical treatment decision when your resident does not have ‘decision making capacity’

OVERVIEW OF THE MTPD ACT

Principles of the MTPD Act

♦ a shift away from a ‘best interests’ model in favour of the preferences and values of the patient ♦ a person’s preferences, values should direct decisions about the person’s medical treatment ♦ a partnership between a person and their family and carers and health practitioners is important to achieve the best possible outcomes

Health practitioners

The Act applies to registered health practitioners in the following professions:

• medical
• dental
• physiotherapy
• occupational

therapy

• chiropractic
• pharmacy
• optometry
• podiatry
• nursing and

midwifery

• medical

radiation practice

• psychology
• osteopathy
• Chinese medicine
• Aboriginal and

Torres Strait Islander health practice The Act also applies to paramedics and non-emergency patient transport staff.

Formal appointments

In Victoria, from 12 March 2018, people can:

• make an advance care directive
• appoint a medical treatment decision

maker

• appoint a support person for their

medical treatment decisions

Appointments made prior to 12/3/18 remain valid

Consent

Health practitioners need a patient’s consent before providing medical treatment, unless they are providing emergency treatment. The MTPD Act sets out the medical consent process for a patient who does not have decision-making capacity to make the medical treatment decision.

‘ADVANCE CARE DIRECTIVE’

Advance Care Directives

An ‘advance care directive’ is a legal document that sets

• ut a person’s:

♦ preferences and values (‘values directive’) and/or ♦ binding instructions (‘instructional directive’) in relation to the medical treatment of that person in the event that the person does not have decision-making capacity to consent to or refuse medical treatment.

Values Directive

♦ a statement of a person’s preferences and values as the basis on which they would like any medical treatment decisions to be made on their behalf ♦ it must be considered by the person’s ‘medical treatment decision maker’

Instructional Directive

♦ a statement of a person’s medical treatment decision that is directed to the patient’s health practitioner(s) ♦ it is only relevant if the person does not have decision- making capacity ♦ the health practitioner must give effect to the instructional directive – provide or not provide the medical treatment ♦ there is no role for a medical treatment decision maker to play

What is not an ‘advance care directive’?

♦ an advance care plan, goals of care plan, end of life wishes form etc ♦ those documents are not transferable to be an ‘advance care directive’; those documents are not legally binding ♦ powers of attorney or wills are advance care planning documents for lifestyle or financial matters ♦ when a person cannot plan for their future: resources

Who can make an ‘advance care directive?

♦ only a person with decision making capacity ♦ cannot be made by anyone else on their behalf ♦ are made in relation to any type of ‘medical treatment’: to consent or refuse medical treatment ♦ people under the age of 18 can also make one, if they have decision making capacity

Advance Care Directive form

♦ in Take Control and OPA’s website ♦ two witnesses – one must be a registered medical practitioner ♦ second witness – and adult over 18 ♦ must meet the procedural requirements to be legally valid ♦ VCAT is the arbitrator

CPR/Not for Resuscitation

♦ is not a ‘medical treatment’ decision that can be speculatively made by a medical treatment decision maker ♦ is a clinical assessment made by a doctor ♦ but should involve discussion with family and/or medical treatment decision maker ♦ doctors are not required to provide ‘futile and non- beneficial’ treatment ♦ patients or family members should not be pressured to complete these forms

‘MEDICAL TREAMENT DECISION MAKER’

Medical treatment decision makers

A person can appoint a medical treatment decision maker with the authority to make medical treatment decisions on their behalf when they do not have capacity to make the decision(s). A patient’s medical treatment decision maker must make the decision that they reasonably believe is the one that the patient would have made.

Medical treatment decision maker

Where a patient is unable to consent to treatment, consent can be obtained from the medical treatment decision maker in the following order:

(1) A medical treatment decision maker appointed by the patient (2) A guardian appointed by VCAT to make decisions about medical treatment (3) The first of the following who is in a close and continuing relationship with the patient and is reasonably available and willing and able: a) the patient’s spouse or domestic partner b) the patient’s primary carer c) an adult child of the patient d) a parent of the patient e) an adult sibling of the patient

‘MEDICAL TREATMENT’

Definition of medical treatment

The definition of medical treatment in the Act has two parts. It is treatment by a health practitioner for one or more of the purposes listed below, and for one of the forms of treatment listed below.

Purpose of treatment Form of treatment

• diagnosing a physical or

mental condition

• preventing disease
• restoring or replacing bodily

function in the face of disease or injury

• improving comfort and

quality of life.

• treatment with physical or surgical

therapy

• treatment for mental illness
• treatment with
• prescription pharmaceuticals
• an approved medicinal cannabis

product

• dental treatment
• palliative care.

Note: The Mental Health Act 2014 applies where a person is a compulsory patient under that Act.

Prescription pharmaceuticals

Like any other type of medical treatment, consent is required. ♦ “a decision to consent to or refuse the commencement

• r continuation of medical treatment”

♦ responsibility of the health practitioner prescribing the medications, however – ♦ if you (a health practitioner) are administering the medications, you need to know a legal consent has been obtained Documentation.

Chemical restraint?

♦ if the medication is not for the purpose of chemical restraint, the MTPD Act states consent must be

• btained

♦ if the medication is for the purpose of chemical restraint, legislative guidance comes from the Disability Act, Mental Health Act or the Quality of Care Principles under the Aged Care Act

OBTAINING A MEDICAL TREATMENT DECISION

In summary

1. from the resident, if they have decision making capacity 2. from the ‘medical treatment decision maker’, if they have one 3. if there is no ‘medical treatment decision maker’ and it is ‘routine medical treatment’ consent not required 4. if there is no ‘medical treatment decision maker’ and it is ‘significant medical treatment’, from the Public Advocate

Step 1. Is there an advance care directive with a relevant instructional directive?

A health practitioner must make reasonable efforts in the circumstances to find out if the patient has an advance care directive with a relevant instructional directive. If the patient has refused the particular medical treatment in their instructional directive, the health practitioner:

• withholds or withdraws that medical treatment.

If the patient has consented to the particular medical treatment in their instructional directive, the health practitioner:

• administers that medical treatment if they are of the opinion that

it is clinically appropriate to do so.

√ Yes

Proceed to step 2

x

No

Step 2. Is there a medical treatment decision maker?

Medical treatment decision maker hierarchy in the new Act 1. The patient’s appointed medical treatment decision maker. 2. Guardian appointed by VCAT under the Guardianship and Administration Act 1986 who has the power under that appointment to make medical treatment decisions. 3. The first of the following persons who is in a close and continuing relationship: (a) the spouse or domestic partner of the patient (b) the primary carer of the patient (c) an adult child of the patient (d) a parent of the patient (e) an adult sibling of the patient. Note: Legal documents made before the new Act commences, are recognised. For example, a medical enduring power of attorney.

Medical treatment decision maker makes the decision to consent to or refuse the treatment.

x √

Proceed to step 3.

Step 3. Is the proposed treatment significant treatment?

Significant treatment means any medical treatment of a patient that involves any of the following:

• a significant degree of bodily intrusion
• a significant risk to the patient
• significant side effects
• significant distress to the patient.

Find Clinical Guidelines about what constitutes significant treatment on the health.vic.gov.au and OPA websites

√ x

Yes No

Decision is made by the Public Advocate. To seek a decision by the Public Advocate, health practitioners complete an online form called a section 63 available on the OPA website The health practitioner may provide treatment without consent if it is routine treatment.

‘Palliative care’ treatment

palliative care includes the following— (a) the provision of reasonable medical treatment for the relief of pain, suffering and discomfort; (b) the reasonable provision of food and water; s.54 Administering palliative care A health practitioner may administer palliative care to any person who does not have decision-making capacity for that care despite any decision of the person's medical treatment decision maker, but in making a decision to administer that care must— (a) have regard to any preferences and values of the person, whether expressed by way of a values directive

• r otherwise; and

(b) consult with the person's medical treatment decision maker (if any)

‘Emergency Treatment’

Definition of emergency treatment Medical treatment (or medical research procedure) that is necessary, as a matter of urgency to:

• save the patient’s life
• prevent serious damage to the patient’s health or
• prevent the patient from suffering or continuing to suffer significant

pain or distress. Consent is not needed for emergency treatment. However, if the health practitioner is aware that the patient has refused the treatment in an instructional directive, they must not proceed with the treatment.

Acting in good faith

A health practitioner who, in good faith and without negligence, reasonably believes they have complied with the medical consent process set out in the Act, is not guilty of an offence or liable for unprofessional conduct or professional misconduct.

Recommended resources

www.healthvic.gov.au

♦ Significant treatment clinical guidelines ♦ A guide to the MTPD Act

www.publicadvocate.vic.gov.au

♦ Can Your Adult Patient Consent flowchart ♦ A clinician’s guide to medical decision making ♦ Your right to make your own medical decisions (Easy Read English)

♦ the ‘Medical Decisions’ and “Plan for the Future’ tabs on the public advocate website

Contact OPA

www.publicadvocate.vic.gov.au Advice Service: 1300 309 337