Death With Dignity

Victorians (Australian) will be able to instruct their doctors to not give them life prolonging treatment for possible future illnesses, under a state government push to allow people to die with dignity.

As a condition of hospital funding, patients will now be encouraged to create “advance care plans” setting out the kind of medical care they would want in the event of illnesses such as dementia, cancer or brain damage.

The directives would give people a greater say on how they want to die – before they lose their decisionmaking capacity – and provide clinicians with guidance to implement their patients’ wishes.

“It’s about providing the support for people to make decisions they believe are important,” said Health Minister David Davis. “This is about their own steps, and to make choices ahead of time, where they could say: well this is a point where I would want certain treatment refused , or I want them continued. Either is relevant.”

At present, about 7 per cent of Australians are believed to have an advance care plan, but in Victoria, any refusal of treatment can apply only to a current illness, not a possible future problem. The government’s strategy, to be announced on Sunday, will take into account future conditions, and will also be tied to hospital funding to ensure such plans are embedded into clinical practice.

For instance, a patient would be able to give their doctor a written instruction that, in the event of rapidly deteriorating health, they would accept intravenous antibiotics but would not want resuscitation, or a transfer to intensive care. They could also use the advance care plan to appoint a substitute decisionmaker . Euthanasia or assisted suicide , however, will remain illegal.

While the move stops short of Victorian Law Reform Commission recommendations to make instructional directives enshrined in law, many have welcomed the strategy as an important shift in clinical practice . “We think it’s a very positive development, as it’s very important for people to be having conversations about end-of-life care,’’ said John Chesterman, policy manager for the Office of the Public Advocate.

Barwon Health intensive care specialist Charlie Corke said it was impossible for doctors and family members to make good treatment decisions for patients unless their concerns and wishes were clearly understood . “It is difficult to think rationally in a crisis. Serious disease may impair clear thinking, and quite often people who are very sick are unconscious , so cannot say anything at all. It is vital that we all plan before a medical crisis, when there is no pressure and plenty of time,” he said.

While some health services, such as the Austin Hospital, already provide advance care planning, the government has been under growing pressure to create greater clarity around their practical effects.

Associate Professor Bill Silvester, director of the Austin Hospital’s Respecting Patient Choices program , said there had been many cases of doctors giving patients treatment they may not have wanted because the patient had lost their ability to decide for themselves. The new strategy would allow people to be better protected in future, he said, and train doctors and nurses to talk to patients while they still had the capacity to work out what they wanted.

He said advance care planning through the Respecting Patient Choices program had also reduced the number of patients who may have otherwise sought euthanasia.

“The reason people look at [euthanasia ] is because they don’t trust that their voice will be heard. This policy is going to be a great step forward for us to deliver a better quality of care to patients at their end of life,” Professor Silvester said.

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