Advance Directives

A health care option still under development.

South Australia is fortunate in having enlightened legislation, the Consent to Medical Treatment and Palliative Care Act, 1995, governing Advance Directives or Living Wills as they are often called. The SA Government has issued information pamphlets describing its provisions and improved pamphlets and forms are being considered.

Despite widespread interest in the Act, it seems that people are slow to actually use it. This may be due to the complexity of the issues involved and to the reluctance we all experience in facing our inevitable death. Eric Gargett, one of the members of a research team appointed to look into this, has summarised his thinking on Advance Directives in the following dot points. They provide a quick introduction to the scope of the issues involved and may be of interest to many of our readers.

An Advance Directive is:

a written or dictated statement of a person's wishes for medical treatment,
made while competent,
in anticipation of suffering from a life threatening condition from which there is no reasonable prospect of remission or recovery and
becoming no longer capable of expressing those wishes.

It may be accompanied by the appointment of an agent with medical power of attorney to interpret and convey those wishes to the attending medical practitioner.

Legislation has to prescribe:

what prior information must be given to satisfy the requirement of informed consent
how those wishes are to be recorded, including witnessing
how they may be revised
how the doctor is to be made aware of the existence of an Advance Directive
the powers of an agent
what obligation rests with the attending doctor to comply
what protection a doctor has who complies with a legal request.

Public reaction is positive but:

many remain unaware of the legislation
others see no immediacy
few take steps to use the law
if they obtain a form or schedule they are unsure what to write.

Doctors seem to be divided in their views:

some are content to remain unaware of the legislation
some do not see it as important
some are resistant to being told how to conduct a case
some who welcome it are unsure how to advise their patients
some are reluctant to give advice because of potential liability.

Conclusions are:

schedules must be easy to follow
ample space is needed for wishes to be recorded
good public relations are vital, including:

free and ample distribution to doctors and the public of brochures which explain the law and how to make effective use of it
information sessions for doctors
talks to community groups
community hotlines for those needing personal advice
follow-up research among doctors and the public.

The Health Commission and the Palliative Care Council are engaged in making this valuable social instrument both more widely known and better utilised. In addition, SAVES has prepared a kit which explains the provisions of the Act and how to go about using it. The kit is available free to members from the Hon. Secretary on receipt of a request with a self addressed flat A4 envelope stamped to 85c.

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