Use these resources when dealing with patients who have lost some or all of their decision-making capacity, for example in advanced dementia.
Understand:
- who becomes the substitute decision maker
- under what circumstanced do you need to obtain consent.
These recommendations are specific for NSW, other states may have different laws.
Resources
NSW Ministry of Health
Consent to Medical and Healthcare Treatment Manual
Source: NSW Ministry of Health
Operational guidance and procedures to support compliance with the NSW law on obtaining consent to medical treatment from patients or their substitute consent providers.
It covers:
- definitions
- capacity
- person responsible hierarchy
- when you do and don’t need consent.
Guardianship division
The NSW Civil and Administrative Tribunal Guardianship Division determines applications about adults who are incapable of making their own decisions and who may require a legally appointed substitute decision maker.
The Guardianship Act (1987) sets out the limits of its responsibilities and functions and the principles to be applied when making decisions.
Information can be found on the Guardianship Division site including:
- Consent for treatment by a doctor or dentist
- Review of enduring power of attorney
- Review of enduring guardianship appointment
- Approval of a clinical trial so that people with a decision-making disability can take part.
- Guardianship orders to appoint a guardian to make personal or lifestyle decisions for someone with decision-making disabilities.
End of life decisions - NSW Health policy
Caring for patients in the ED who are nearing the end of life is complex and at times challenging. These are the NSW policy points on consent at the end of life:
- A medical practitioner does not need to obtain agreement from the patient or family to withhold interventions considered to be of negligible benefit.
- It is still good clinical practice to discuss why these are not being offered in the context of broader end of life goals of care conversation.
- If consent it not sought, the reasons why should be documented in the patient record.
Refer to the end of life clinical tool for more detailed patient management.
Guidelines for end of life care and decision making (GL2021_004)
Advice about a process for negotiating end of life decisions.
Source: NSW Ministry of Health
Related information
- Capacity Australia
Training and resources supporting decision making.
Accessed from the Emergency Care Institute website at https://aci.health.nsw.gov.au/networks/eci/clinical/tools/capacity