Advance Care Directives Act in SA
Advance Care Directives - A clear path to care
Information provided by SA Health
The Advance Care Directives Act 2013 and changes to third party consent come into effect 1 July 2014. Together these changes pave the way for a rights-based, person-centred approach to health care and decision-making.
The Act provides a clear decision-making framework and new protections when clinicians find themselves in the difficult position of trying to determine what a patient in your care might want, at a time when their ability to make decisions is impaired.
The Act simplifies future decision-making by allowing people to put in place clear legal arrangements for future health care, residential and other personal matters in a single Advance Care Directive (ACD) form. This form will replace the Enduring Power of Guardianship, Medical Power of Attorney and Anticipatory Direction (however any of these existing forms will continue to have legal effect post 1 July 2014).
The ACD Form also allows individuals to appoint Substitute Decision-Makers and /or to clearly document their wishes with respect to their future health care, living arrangements and personal matters.
This information will make it easier for clinicians to make decisions that are fully informed and considerate of patient wishes, values and well-being.
1 July 2014 also sees major changes to legislation in regards to the list of potential people who can provide consent or refuse consent for health care for a person (over 16) who has impaired decision-making capacity (under the Consent to Medical Treatment and Palliative Care Act 1995).
There will be a clear legal hierarchy of decision-makers when health professionals are seeking consent for health care and the patient does not have capacity to make their own decision. The hierarchy follows this order: Substitute Decision Maker (SDM) (if any appointed), patient wishes (that amount to consent/refusal), Persons Responsible. All decision-makers must make a decision they believe the patient would have made- that is they must ‘stand in the patients’ shoes’.
New protections come into play for health professionals for complying with an ACD in good faith and without negligence as well as when making decisions for a patient if acting in good faith and in emergencies if there is no time to contact a SDM or clarify wishes in an ACD. There will not be a requirement to provide treatment which is not considered to be of benefit to the patient.
Health practitioners can now be more confident and consistent in the process- and both the patient and health practitioner are protected.
Education and training materials available
A range of education and training materials are available on the SA Health website to assist health practitioners understand the new Advance Care Directive legislation and changes to third party consent. These include fact sheets, Frequently Asked Questions, a training video and other relevant resources. To view these please visit teh SA Health website here. A Fast Facts info sheet from SA Health and a copy of the Advance Care Directives Form are attached at the bottom of this page.
Advance Care Directive Form and DIY Kit
The Advance Care Directive Form and DIY Kit is available to the public from 1 July 2014, either in hard copy or electronically. Hard copies can be purchased from Service SA in person, over the phone or electronically from the Advance Care Directives website (using the shopping cart) and cost $5 for the Kit and $1 for the form. Electronic copies are free from the website. People can also complete their ACD Form online using the new interactive web form. The Legal Services Commission can provide advice to the public on completing their Advance Care Directive Form and assistance with witnessing.
The Advance Care Directives Act has also meant changes to the Consent Act. Fact sheets and FAQs in relation to these changes can be found here.
The AMA(SA) supported the 2013 passage through SA Parliament of the Advance Care Directives Act, with several important amendments advocated for by the Association (see our submissions here and here and a helpful overview here). The AMA(SA) also provided feedback on a draft Advance Care Directives toolkit.
The Act presents great potential but for it to achieve its admirable objectives the implementation will be key.
Part of this involves making information clearly and easily available to the public and to medical and other health practitioners about the new Act and the provisions for Advance Care Directives, though which people can make their wishes about treatment and other matters known.
Below are PDFs of some more information and resources regarding Advance Care Directives, including a series of articles drom AMA(SA) Councillor Dr Chris Moy on teh Advance Care Directives Act and the 7-Step Pathway.