NUR1113 Lecture Notes - Lecture 5: Privacy Act 1988, Palliative Care, De-Identification
NUR1113 – Law, ethics and an introduction to leadership in nursing and midwifery
Module 5 – Refusal of treatment and NFR/withdrawal of treatment, privacy and confidentiality
Learning Objective 1: Outline the purposes of the Medical Treatment Act 1988 (VIC) and discuss the differences
between withdrawal of treatment, refusal of treatment and not for resuscitation (NFR)
Legislative frameworks (Victoria)
The Victorian legislation established two mechanisms that allow patients to refuse treatment
• Optios①for①Dig①ith①Digit①→ Enacted Medical Treatment Act 1988
o Deals①ith①patiets/agets①refusal①of①treatet①
• Guardianship and administrative act 1986 →
o Deals①ith①guardias,①perso①resposile①ad①edurig①poer①of①attore①ad①refusal①of①
treatment
Medical Treatment Act 1988
Purpose:
a) Clarify the law relating to the rights of patients to refuse medical treatment
b) Establish a procedure for clearly indicating a decision to refuse medical treatment
c) Enable agents to make decisions about medical treatment on behalf of an incompetent person
• Act allows competent adults to indicate parameters of care (does not apply to children) via completion
of①Refusal of Treatet Certificate’ (Schedule 1)
• ②llos①patiets①appoited①aget①to①ake①deisios①o①ehalf①of①the①patiet①if①the①eoe①iopetet①
(Schedule 2)
• Agent or guardian can refuse treatment on behalf of patient (Schedule 3)
Features of Medical Treatment Act (1988)
Refusal of medical treatment:
Medical treatment involves:
a) An operation
b) The administration of a drug or other like substance; or
c) Any other medical procedure (Excluding palliative care)
Schedule 1 – patient refusal of treatment
• Patient must be competent (sound of mind and 18+ years)
• Must be voluntary
• Requires signature of two witnesses, one who must be a medical practitioner
• Both witnesses must be content that all criteria have been met
• Includes a section making it an offence for medical practitioners to continue to provide treatment once
the certificate is signed
• Must be given sufficient information and understand the information
• Patient must understand what signing the certificate will mean
‘efusal an e general or speifi
Example:
• I want to be kept comfortable in these circumstances or
• I①dot①at①a①ifusio①of①hole①lood①produts①
Palliative care:
Cannot be refused!
a) The provision of reasonable medical procedure for the relief of pain, suffering and discomfort
b) The reasonable provision of food and water
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Current condition/diagnosis
• Refusal can only apply to the current diagnosis or condition
• Current condition must be identified by a medical practitioner
• Poses difficulties for①people①atig①to①idiate①future①treatet①he①the①dot①urretl①hae①a①
diagnosis
Schedule 2 – Agent making decision on behalf of patient
• Enduring power of attorney → when used in context of refusal of treatment → Enduring Power of
Attorney (Medical Treatment)
• Cannot come into place until patent becomes incompetent
• The patient/donor must be legally competent and must choose the agent who will make decisions on the
patiet/doors①ehalf
• Important that the patient/donor trusts the agent to carry out their wishes and that they respect the
beliefs of the patient/donor
• The①agets①poer①eteds①to①proidig①oset①t①treatet①ad①to①refuse①or①ithdra①oset①for①
treatment
Schedule 3 – Agent or guardian to refuse treatment
• Agent can only refuse treatment if the treatment would cause the donor unreasonable distress or the
agent believes, on reasonable grounds, that the donor would not want treatment to continue
• Competent donor can cancel a medical enduring power of attorney at any time
• If there is reason to believe that the agent is not making decisions as the donor intended or is abusing
their power, the Guardianship and Administrative Board may revoke or suspend the power of attorney
• Refusal of Treatment can be made by:
o Competent person who is able to consent
o Supreme court of each State and Territory
o Substitute decision makers → Agents appoint by patients under Medical Enduring Power or
Attorney, or a guardian appointed by VCAT
Medical treatment rights (Victoria):
• Right to refuse medical treatment in most circumstances (if conscious and has the legal capacity to make
decisions)
• The①edial①pratitioer①ust①usuall①seek①the①persos①oset①prior①to①arrig①out①edial①treatets①
(law of consent)
• ②①persos①apait①to①oset①is①assued①unless there are indications otherwise
• A competent person can refuse treatment in relation to their current condition under the Medical
Treatment Act 1988 by completely a Refusal of Treatment Certificate
• ②①persos①medical enduring power of attorney or VCAT appointed guardian can complete a Refusal of
Treatment Certificate on behalf of the person if they no longer have the capacity to it themselves
find more resources at oneclass.com
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