A clinician's guide to medical decision making for when the person lacks capacity to undertake advance care planning

This guide covers five areas that relate to making medical treatment decisions for a person who lacks medical decision making capacity to consent to their own treatment or to refuse that treatment:

• How should medical decisions be made?
• How can the medical treatment decision maker know what the person would want?
• What challenges can a medical treatment decision maker expect?
• What is the form ‘What I understand to be the person’s preferences and values’?
• How are a person’s preferences and values translated into a medical treatment plan?

Download A clinician's guide to medical decision making >>

The form, ‘What I understand to be the person’s preferences and values’, is available to download from the Northern Health website.

Medical treatment decision making  and advance care planning for  people living with dementia

Any person with decision-making capacity can engage in advance care planning. This includes people living with dementia.

A person with dementia should be encouraged to consider likely future health conditions and treatments relevant to their condition, and be given adequate information so that if they wish to make an instructional directive they are properly informed.

If the person with dementia does not have decision-making capacity to appoint a medical treatment decision maker or support person, or complete an advance care directive, it does not mean that they cannot express their preferences and values. They should be encouraged and supported to do so now, and at regular future points in time.

Download the fact sheet: Advance care planning and people living with dementia >>

Advance care planning and substitute medical treatment decision making

Advance care planning is done by a person for themselves, when the person has decision-making capacity for the decision(s) in question.

Substitute decision-makers must make the medical treatment decision that they reasonably believe is the decision that the person would have made if they had decision-making capacity.

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Advance care planning in residential aged care facilities

An adult is presumed to have decision-making capacity, unless there is evidence to the contrary. This presumption includes residents of residential aged care facilities

A diagnosis of dementia does not in itself mean that the person lacks decisionmaking capacity for any specific decision.

The point of advance care planning is to promote the autonomy of the person. Therefore, if the person elects not to appoint a medical treatment decision maker or support person or complete an advance care directive, such choices should be accepted and respected.

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Policy Position: Signing Residential Aged Care Facilities’ Advance Care Planning Documentation

Advocate/Guardians at OPA are instructed not to sign any Residential Aged Care Facility (RACF) documentation which purports to be a ‘Not for Resuscitation’ decision as this would be beyond their legal authority.  

Our advice to family members similarly is not to sign such documentation. Our advice to RACF is not to ask family members to sign such documentation.

Download OPA's Policy Position: Signing Residential Aged Care Facilities’ Advance Care Planning Documentation >>