I am a lawyer who works in estates, guardianship and administration, advance care planning, family provision claims, succession and other related areas of law. I have the privilege of sitting on a number of committees, namely the Law Society’s Elder Law and Succession Committee, the WA Health Department’s Advance Care Planning Committee, the Law Reform Commission of WA in respect of the review of the Guardianship and Administration Act and I also attend meetings with Palliative Care WA.
My cross section of committee work enables me to engage with members of the medical profession, in particular doctors and health care professionals, who work closely with patients relying on advance care planning documents.
I asked Dr. Margherita Nicoletti, Consultant – Palliative Medicine at Peel Campus and the Clinical Lead – End of Life Care at the Health Department what she wants lawyers to know when working with clients to advise and when drafting advance care planning documents.
Dr Nicoletti’s advice was practical, simple and achievable:
- plain English – use plain English to provide instructions that are clearly stated so that they can be readily interpreted, understood and applied by medical staff, particularly by medical staff working in urgent or emergency settings.
- be clear and concise – imagine an emergency doctor working in a high pressure, time sensitive medical crisis. Medical practitioners need instructions that leaves them in no doubt about which treatments a patient consents to or wishes to exclude.
- Advance Health Directives (AHD) – where possible, AHD are best, but they also work better when supported by an Enduring Power of Guardianship (EPG).
An AHD supported by an EPG is recommended as not all potential medical scenarios that a patient might face can be contemplated and foreshadowed in an AHD alone.
Doctors recommend patients complete the sections of the AHD that they understand and that align with their personal values, wishes and preferences. To cover all possible situations, an EPG appoints a substitute decision-maker to make decisions which cover situations outside of the AHD. The two documents should work together to provide clear and comprehensive instructions as seamlessly as possible.
The combination of AHDs and EPGs greatly assists doctors to ensure the best treatment and care outcomes for the patient by:
- efficiently delivering medical care and treatment; and
- knowing who to speak to in the event that additional treatment instructions are required.
Doctors also encourage lawyers to:
- prepare Advance Care Planning documents while your client is well and able to do so. It is not something that should be ‘left for later’ or when they are older. Many young people find themselves having to rely on these documents too; and
- consider the reader when planning documents. Use the correct forms; write in plain English and be unambiguous.
The experience of supporting families of clients who are seriously unwell in Intensive Care or are at an End of Life stage, is a privilege.
By following these suggestions, the legal profession can materially assist doctors to deliver care that accords with a patient’s values and expressed wishes. When done well and done early, advance care planning provides clarity in crisis, confidence for clinicians and reassurance for families.
A win-win for all.
