The AMA has adopted a formal position on advance care planning.
At its meeting on 18 August the AMA Federal Council debated the matter at length, and finally voted in favour of the statement supporting consistent advance care planning legislation across all Australian jurisdictions. Advance Directives (generally used in relation to end-of-life decisions) currently have an ambiguous legal status in most Australian jurisdictions, including Victoria. Fundamental to the legislative requirements proposed in the AMA Statement is respect for patients’ wishes, in the context of good medical practice and the protection of a doctor who complies with the directives or who declines to comply for valid medical reasons.
The impetus for the federal body’s finalisation of the position statement came from AMA Victoria’s intensive examination of all the issues, and Victorian President Dr Mark Yates was a leader in the development of the position statement. The Victorian Council and Board addressed the issue at a number of meetings, after support by the Council for a motion proposed by independent Council member Dr John Mathew, and the two groups took extensive policy and legal advice before reaching a position that is supported in the federal statement.
“The AMA respects the important role advance care planning plays in facilitating patient autonomy and self-determination in health care decision-making,” said federal President Dr Mukesh Haikerwal.
“As part of the advance care planning process, the AMA supports the use by patients of advance directives and/or the designation of a surrogate decision-maker, such as an Enduring Power of Attorney.
“The doctor has a key role to play in developing individual advance care plans by providing guidance and advice to patients, in discussing treatment issues and options relating to future incapacitating conditions, and discussing what future health care options might be available.
“The AMA upholds patients’ rights to make decisions about their health care in advance.
“However, we also believe that making decisions in advance cannot always encompass every unforeseen possibility, option or health care scenario.
“While respecting the role of patient autonomy in the advance care planning process, doctors’ clinical independence must be protected in order for them to act in the best interests of their patients.”
Dr Haikerwal said the AMA is calling for clear, nationally consistent advance care planning legislation that recognises this clinical independence.
It is envisaged the Advance Care Plan would be used in decision-making when
(a) the patient is in the terminal phase of a terminal illness or condition that is incurable and progressive and is likely to die within a few months at most, or
(b) the patient is in a persistent vegetative state or coma or
(c) the patient has an illness or an injury of such severity that there is no reasonable prospect that he or she will recover to the extent that his or her life can be sustained without the continued application of life-sustaining measures, and/or has no reasonable prospect of regaining decision-making capacity.
Dr Yates welcomed the adoption of the position statement, which he noted addresses the serious ethical, clinical challenges to the health care team that may arise if the circumstances that existed at the time the advance directive was made may have changed or if the patient has used may use ambiguous terms in the directive that make interpretation difficult.
He notes that in these cases doctors should be under no absolute legal obligation to follow an advance directive which is not consistent with Good Medical Practice. The statement also acknowledges the right of a doctor to excuse themselves from following a valid advance directive if the have a conscientious objection.
However, in the case of a doctor following a valid directive in good faith, there will be no possibility of legal action from aggrieved relatives of the patient, and legislation as proposed will protect these doctors, Dr Yates said.
Dr Yates welcomed the adoption of the position statement by the Federal Council and acknowledged the work of the Victorian Council in its development.
The full statement on advance care planning can be found on the Federal AMA website.