Do health professionals always need to follow decisions recorded in an Advance Health Directive?
Yes. In most situations, if a person becomes unable to make or communicate decisions about their treatment and care, health professionals must follow the decisions in their Advance Health Directive, except in some limited exceptions. A limited exception may occur if:
- circumstances relevant to a treatment decision have changed since the person made the treatment decision, and
- the person could not have reasonably anticipated those changes when they made their Advance Health Directive, and
- it is likely that a reasonable person with knowledge of the change of circumstances would change their mind about the treatment decision.
I have concerns regarding the person’s (Enduring) Guardian – what should I do?
A person’s enduring guardian must act in the best interest of the person.
If health professionals have concerns about an enduring guardian, it is important to talk to others involved in the person’s care. It could be helpful to arrange a meeting with the person’s enduring guardian and the treating medical team including social work, to try and resolve it. If apprehensions remain, an application can be made to the State Administrative Tribunal (SAT) (external site) detailing the concerns.
I have concerns regarding the circumstances in which an Advance Health Directive was created – what should I do?
If health professionals have concerns, firstly they could discuss these with the person if possible. Health professionals may also check if the person has listed the details of person(s) they have contacted for medical or legal advice and discuss concerns with them. If the person lacks capacity, then it is important to discuss concerns with the person’s usual medical team or identified decision maker as per the hierarchy of treatment decision-makers (PDF 1.6MB). If concerns remain, an application can be made to the State Administrative Tribunal (SAT) (external site) to determine the document’s validity.
The person’s Advance Health Directive consents to treatment I do not consider to be appropriate – what should I do?
People can sometimes write down treatment decisions which health professionals may disagree with, but these decisions may still be valid.
The Advance Health Directive may not be used to demand treatment which is not clinically required. The first step is to discuss with the person (and where possible, their usual treatment team) the best option for the person’s treatment at that time.
If the person lacks capacity, this discussion should be made with the relevant substitute decision maker as per the hierarchy of treatment decision-makers (PDF 1.6MB).
The person’s Advance Health Directive does not cover their current situation – What should I do?
If the person has capacity
Health professionals should obtain consent from them prior to initiating any treatment.
If the person’s current situation is likely to recur and the treatment in their current Advance Health Directive will have a significant impact, then providing the person has capacity, they may consider making a new Advance Health Directive and revoking the previous one.
If the person has lost capacity
And the treatment decisions contained in their Advance Health Directive do not meet their current non-urgent medical requirements, health professionals must refer to the hierarchy of treatment decision-makers (PDF 1.6MB) and contact the correct person for consent.
If an urgent decision is required, the health professional’s treatment decisions must be based on the person’s best interests.
The person’s Advance Health Directive and their enduring guardian/family are seeking different treatments – what should I do?
Once a person has lost capacity, the hierarchy of treatment decision-makers (PDF 1.6MB) must be consulted to clarify who to approach for consent. The Advance Health Directive must be followed first and if valid, will overrule the wishes of the enduring guardian in these circumstances.
If the family remain concerned, they can apply to the State Administrative Tribunal (SAT) (external site) to determine the validity of the Advance Health Directive.
The person, within the hospital in which I work, has given me their Advance Health Directive – What should I do?
Make sure that the person retains their original Advance Health Directive and they are giving the health professionals a copy (preferably a certified copy).
If they have given the health professional their original Advance Health Directive, health professionals can make a copy and return the original Advance Health Directive back to them.
The Advance Health Directive should be prominently placed within the patient’s file and where possible uploaded into the electronic medical record. It is important that health professionals follow their relevant organisational guidance and practice in relation to managing this document. For health professionals within WA Health, refer to relevant statewide policies for the storage of advance care planning documents:
What if nobody can access the Advance Health Directive in an emergency situation?
Treatment is regarded as urgent or an emergency if it is needed to save a person's life or prevent the person from suffering significant pain or distress.
Where a person requires urgent treatment and it is not practicable for the health professional to determine whether an Advance Health Directive has been made or to obtain a treatment decision from anybody in the hierarchy of treatment decision-makers (PDF 1.6MB), the health professional may provide the necessary treatment.
In cases where a person is in need of urgent treatment that the health professional believes is the result of attempted suicide, the health professional may administer the necessary treatment even:
- if the person has made an Advance Health Directive in which consent for the required treatment is withheld
- the person's guardian, enduring guardian or person with authority to make a decision withholds consent.