New legislation creating ‘binding advance care directives’, which passed the Victorian Parliament this week, poses a threat to patient choice and medical practice, according to the Australian Christian Lobby.
The Medical Treatment Planning and Decisions Act 2016 allows patients to make binding written statements in advance about the kind of medical treatment they consent to or refuse as well as the preferences and values on which the person would like any medical treatment decisions to be made.
ACL Victorian director, Dan Flynn, said by making advance care directives legally binding there was a risk doctors would provide or withhold treatment that does not reflect the kind of choices the patient would actually make if they were conscious.
“These binding directives, if written years before or written in a different state of mind, might not reflect the current wishes of a patient,” Mr Flynn said.
“There is no review or expiry on these documents, so the surrounding conversations around the current medical situation are important to ensure the medical team is not implementing instructions that are no longer wished by the patient or family members.
“The legislation is onerous for the medical profession which will be bound to follow these directions, even if they prevent basic medical assistance, under threat of deregistration.
“We see directives as an important part of a holistic approach in medical care, but they shouldn’t be made binding. That’s where we think it has gone too far,” he said.
“Research into the success of advance care planning models, and their effectiveness in ensuring that care is carried out according to patient choices, shows that directives by themselves are not sufficient in ensuring that care outcomes are consistent with patient desires.”
Research conducted by Alfred Health indicate that directives were not always sufficient in complex medical scenarios to ensure that an individual’s choices are respected.
“These results point to the need for a holistic approach to advance care planning,” Mr Flynn said.
“Forcing doctors, under threat of deregistration, to comply with patient written directives, which may be decades old, will not assist towards that goal.
“The ACL calls on the Victorian Government to consider amending these punitive laws to create flexibility for patients and their families.”
 Cairney H, et al. ‘Can community dwelling older adults complete a person based Advance Care Directive to provide useful information to substitute decision makers?’ Research Results Alfred Health n 2.