Refusal of treatment
The requirements for refusing medical treatment depend on whether or not the patient has the ability to make their own decision and is able to consent to medical treatment.
A person appointed as a medical agent under an enduring power of attorney (medical treatment) or a guardian appointed by the Victorian Civil and Administrative Tribunal (VCAT) with medical treatment decision-making powers can refuse medical treatment on behalf of a patient who cannot consent.
To do this, the medical agent or guardian must sign and have witnessed a 'Refusal of Treatment Certificate: Agent or Guardian of Incompetent Person' form (right menu). They specify the type of treatment they wish to refuse. No doctor can provide the treatment that has been specifically refused in the certificate.
To sign, a medical agent or guardian must:
- have been given sufficient information about the patient’s condition
- understand this information
- understand what they are doing by signing the certificate
- make the decision voluntarily (advice can be given, but they must not be coerced)
- hold the view that either the medical treatment would cause the patient unreasonable distress, or there are reasonable grounds for believing the patient would, if competent and after serious consideration, have considered the treatment unwarranted.
Anyone who has a genuine interest in the patient’s welfare can ask VCAT to consider the actions of the medical agent or guardian. VCAT can suspend or cancel an enduring power of attorney (medical treatment) if the medical agent is not acting in the patient’s best interests or cancel a guardianship order if a guardian is not acting in the patient’s best interests.
If this happens, then any certificate signed by the medical agent or guardian is also cancelled. VCAT sends a written notice confirming this to the hospital or nursing home.
A patient 18 years of age or older who has the capacity to understand the decision they are making can refuse medical treatment for a current medical condition by signing a Refusal of Treatment Certificate: Competent Person form (right menu). This cannot be used to refuse palliative care such as pain relief, and food and water while the patient is still able to eat and drink.
For it to operate, a doctor and another person must sign the Refusal of Treatment Certificate: Competent Person form to verify that the patient is refusing treatment. The certificate specifies the type of treatment being refused and a doctor can only provide treatment consistent with the terms of the certificate.
It is illegal for medical practitioners to treat a patient if they know there is a valid certificate in force.
Most certificates will be signed in hospitals or other facilities, but they can also be signed at home.
The doctor who witnesses the certificate, or the manager of the hospital or facility, must give a copy of the certificate to VCAT within seven days.
If the patient is competent, the certificate can easily be cancelled at any time by the patient clearly expressing or indicating that they want to cancel it. This can be in writing or by other forms of communication.
The patient making the certificate must:
- have been given sufficient information about their condition
- understand this information
- understand what they are doing by refusing treatment
- make the decision voluntarily (advice can be given, but they must not be coerced).
The doctor and the other person must be satisfied that these requirements have been met.