Consent when prescribing to dementia patients
Responsibility rests with doctors to obtain family consent before giving anti-psychotics to dementia patients in nursing homes, but administrators in the aged care facilities have the responsibility to administer them correctly.
Chair of the AMA Ethics and Medico-Legal Committee, Dr Chris Moy explained where the onus falls when it comes prescribing such medications in an aged care facility.
“At the end of the day the right to prescribe is inextricably linked to the responsibility to prescribe,” Dr Moy told ABC News.
“So, at the end of the day … if I have to sign a medication order or prescription, I'm responsible for that, and so therefore responsibility to obtain consent for that rests with me, ultimately.
“Obviously (nursing home administrators) need to ensure that the order that I've written is administered in the correct way and under the right circumstances, but that's a separate issue to the actual prescribing and writing of the order.”
Dr Moy explained that there is a reasonably good framework in most jurisdictions for maintaining order in prescriptions.
“It's pretty straightforward. At the end of the day, it is a matter of consent,” he said.
“So, firstly, as a doctor, before I actually provide treatment to anybody, I need to obtain consent from them, I need to say ‘will you accept if I do this to you?’ and this also applies to an individual who’s lost decision-making capacity, for example, someone's who got severe dementia.
“Now, in that situation, somebody should be representing them, which is why we really advocate for people to have advanced care directives or appoint decision-makers for them, so that we can ask them on the patient's behalf.
“And their job – the job of that individual – is to do what that patient would have wanted. And so, my job is to say ‘look, what would your loved one have wanted in these circumstances?’ and, knowing the information, ‘this is what's happening, and maybe there may be issues of behaviour or violence that may be happening or confusion, or they may be shouting things that may be very distressing. In those circumstances, knowing that information, would your loved one … want this this to be prescribed to them?’
“I think one of the issues is that, unfortunately, there is a chronic underfunding of aged care and, unfortunately, situations like the Oakden situation probably give us a bit of an insight into that. And I think that's what we found.
“For example, as a GP, I actually have to provide a lot more time to a patient. I have to go down and see a patient but also have to take the calls out of hours, which is not remunerated, contact the decision-maker to try and get consent for that, and that may not always be possible.
“And so, those sorts of things have to be factored in. So, in amongst the issue of the prescribing and obtaining consent is the need for proper funding, not only of the doctors providing the care but also of the facilities themselves, so that the patients get appropriate care, and appropriate supervision and appropriate administration of their medications…
“Ultimately, you're looking at medications as a last resort, and then going through the proper consent process so that the doctor first-up ensures that they get consent from the right person, and that person giving consent is the legally appropriate individual but is also acting for the patient and doing what the patient would have wanted.”
Published: 01 Feb 2019