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Doctors unclear on advance care planning laws

Professor Colleen Cartwright

Professor Colleen Cartwright

Many doctors are confused about the legality of advance care directives and the authority of substitute decision-makers, leaving them open to possible legal action, new research has found.

According to the study led by Professor Colleen Cartwright from Southern Cross University only half of surveyed doctors in New South Wales correctly understood that an enduring power of attorney does not allow the person appointed to make healthcare decisions.

Doctors were also unclear about the order of authority if no enduring guardian had been appointed, which in NSW is not the next-of-kin.

Professor Cartwright said a lack of knowledge in this area may lead medical practitioners to accept the decision of a person who does not have legal authority to make those decisions for the patient, with potentially significant legal consequences.

“Medical practitioners need to understand who has the authority to consent for someone who has lost capacity and are putting themselves at legal risk if they don’t follow a valid advance directive or the instructions of an appointed or legally authorised substitute decision-maker,” she said.

Further education

While the majority of doctors (77 per cent of specialists and 76 per cent of GPs) in the study said they would respect the patient’s autonomy and follow their wishes in an advance care directive, older doctors were least likely to agree with this action.

Professor Cartwright said further education and training would need to target this cohort in addition to strengthening training in medical schools for new graduates.

The standardisation of terminologies and systems across different states and territories would also assist in addressing these issues, she said.

“My message to healthcare professionals is to know the law in your state or territory, respect the documents and the appointments that have been made unless you have a very good reason for doing otherwise and encourage your patients, residents and clients to complete their documents because it will give you certainty and the patient certainty.”

The results of the study, which surveyed 150 GPs and 110 medical specialists, were recently published in the Internal Medicine Journal.

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