An ounce of prevention is worth a pound of cure, and that doesn’t just apply to literal medicine. Some patients choose to proactively plan decisions and intended outcomes for their future health care, assuming that certain conditions come to pass, known as advance care planning. This can provide peace of mind for the patient
However, it isn’t as simple as it sounds. There are a number of prerequisites an advanced care directive needs to fulfill in order to be carried out—and a lot of the responsibility in legally and ethically actioning said direction falls upon the doctor.
This is what you need to know for ensuring the best outcomes for your patient, their families and yourself.
There is increasing recognition (Rights 4 and 6 of The Code of Health and Disability Services Consumers’ Rights (“the code”)) that advance care planning forms part of providing an approved standard of care. Advance care planning can help reduce uncertainty in the limited circumstances under Right 7(4) of the Code or in emergency situations where health professionals need to make decisions on behalf of a person who lacks capacity and has no authorised decision maker.
Advance care planning is the process of discussion and planning for an individual’s health care in the future. This process is between the individual and their health care professional. If the individual wishes, it can also involve the individual’s family or carers. It is an opportunity for the individual to develop and discuss their health care preferences and incorporate these into a plan for future health care. This may result in the individual choosing to write an advance care plan or advance care directive. They may also decide to appoint an Enduring Power of Attorney.
The Code defines an advance directive as a written or oral directive:
a) by which a consumer makes a choice about a possible future health care procedure; and
b) that is intended to be effective only when he or she is not competent.
Right 7(5) of the Code provides that every consumer may use an advance directive in accordance with the common law. The directive is often referred to as a “living will”.
An advance directive is legally binding under the Code only if a certain standard is met. Before acting in accordance with the advance directive there are a number of steps that you should take to determine whether it meets this standard.
a) Ensure the advance directive was made without undue influence;
b) Confirm the patient was competent and fully informed about the consequences of the decision;
c) Check whether the patient intended the advance directive to apply to the situation before you;
d) It is also advisable to verify whether the patient had reviewed the advance directive recently; and
e) In the event of a conflict between the family’s wishes and the advance directive you should seek advice from your colleagues, an ethics committee or NZMPI.
An advance care plan is the articulation of an individual’s wishes, preferences, values and goals for future health care. It is the product of the advance care planning process. It should be used to inform decision-making regarding a patient’s health care, in conjunction with measures such as consultation with the patient’s Enduring Power of Attorney. It is not legally binding unless it meets the criteria for an advance directive.
Current as at 19 September 2018
For more information about advance care planning and directive, get in touch with NZMPI’s dedicated medico-legal advisory team.