Planned Care Agreement/Advance Care Directive/Enduring Power of Attorney
Part I
Death is often forgotten as the basic law of life. It can come in any form or shape and more often than not when it is least expected. But the general human experience is that death comes at old age after an individual (he or she) had enjoyed healthy and fulfilling life and left familial progeny. The challenge that is often faced by a spouse, child, or a grand child is a decision respectful of mum, dad, grandfather, grandmother, or indeed one’s loved one or carer to end one’s life or prolong one’s agony, suffering and mental anguish. Would I want one of my grandparents, parent, a wife or a sibling who is in Intensive Care with tubes and monitors stuck or inserted into his or her body and whose heart had stopped resuscitated? If that loved Family Member had left a document stating his or her wishes in such situation authorizing family member to make decisions in accordance with those wishes such a document would not only save untold remorse and agony but more importantly disputes and finger pointing between family members.
The mindset, training, and expectation of health practitioner in emergency and intensive care setting is to treat and resuscitate a frail elderly patient whose most likely wish if he or she had a say is to go peacefully. The untold fact is that five percent (5%) of patients whose heart had stopped and were resuscitated in intensive care ever make it out of hospital. Those five percent who do make it often after short period return to die more agonizing death. Legal issues can and indeed do arise for non intervention by health practitioners who are by no mean immune against civil suits by grieving and disgruntled family member or members. Indeed this scenario could equally apply if the now deceased patient had left advance care authority or enduring power of attorney spelling out his or her wishes in such scenario. Whilst there had been some legal decisions whether to treat or not treat it is still an area with wide shades of grey for both the medical and legal professions.
Treating someone who is elderly against his or her wishes would constitute an assault on that someone especially if those wishes are made with undisputed mental capacity. They could range from refusal to eat or drink, refusal to have blood transfusion, refusal to be intubated and forced fed or medicated against his or her will. Imagine an elderly legal or medical practitioner in his or her 80’s blatantly refusing treatment having his or her arms and legs tied to bed and tube inserted to force feed or medicate him or her. To me this is the most serious form of assault, undignified assault made under the pretence and purported protection of the medical profession though not necessarily against the wider or strict interpretation of the ethics of that profession. It should, in my opinion be punishable as a crime under the Crimes Act of the State or Territory concerned and carries mandatory jail sentence.
In Part II I will look at recent court decisions and the issues that could arise when a person had entrusted someone with authority to make decisions in accordance with his or her wishes.
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