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Used or Abused?
The Medical Treatment Act (Victoria) 1988
Honoured more in the breach than the observance.
By Richard M. James
The Medical Treatment Act allows patients to instruct doctors about
end of life treatment decisions, and the Act purportedly protects doctors
honouring those instructions. The reality however, is that few patients
make their wishes known in advance, relatives and those holding medical
power of attorney are not empowered to ensure the patients wishes are
honored and doctors are well known for avoiding the discussion. Over
70 concerned citizens and health professionals recently attended a forum
in the St Kilda Town Hall, Melbourne. The forum was organised by The
Inner South East Partnership in Community Health – a primary care
partnership of over 40 health and community care services in the cities
of Glen Eira, Stonnington and Port Phillip - together with The City
of Port Phillip’s Older Persons Reference Group.
The forum was chaired by Councillor Carolyn Hutchens of the City of
Port Phillip. Cr Hutchens says that the aim of the Act was to facilitate
‘dying with dignity’ and people’s right to refuse inappropriate
medical treatment when they are near the end. Cr Hutchens believes the
Act is relevant to all people, as serious injury can occur at any time
and it is not only the old who face medical calamities. In her opening
address Cr Hutchens outlined in detail the problems and issues we face
such as the fact that few people, including medical professionals, have
any understanding of the laws relating to this issue. The first speaker
to address the audience was Ms Muriel Arnott, community activist and
long time physiotherapist, working in aged care.
Ms Arnott told a personal story about the death of her father. A tale
of misunderstanding, invasive medical procedures, lack of proper history
taking, lack of reporting, and battles which had to be fought time and
time again. The patient and the family were denied a dignified death,
despite having all the correct paper work for medical power of attorney,
causing extreme anguish to all concerned. Ms Arnott was followed by
Mr Julian Gardner, The Public Advocate, who gave a concise and precise
run down on The Act, Medical Enduring Powers of Attorney, Refusal of
Medical Treatment Forms and Enduring Guardianships. Mr Gardner supplied
details of both recourses and resources. He also outlined the ambiguity
of the Act and failure of observance through lack of knowledge and definition.
Dr Ngaire Ellis, a private practitioner who also works with The Mobile
Assessment and Treatment Service at The Alfred Hospital, spoke of a
project to discuss and document at nursing home level, patient’s
choices for care in the final stage of their life be it pro-active or
palliative. The formal content of the proceedings concluded with an
address by Ms Melodie Heland, Project Officer at Melbourne’s Austin
and repatriation Medical Center Pilot Program, to increase the understanding
and use of advance directives within the hospital and community. This
program is based on a US program, “Respecting Choices”. The
program includes awareness and education, proper documentation and training
both professionally and generally.
The forum saw a lively and very participatory session of questions from
the floor and answers by the panel of speakers. In general the comments
and questions put to the panel sought further explanation and clarification
of that which had been said previously. The meeting concluded with a
summing up from the chairperson suggesting that further education, clarification,
and possible amendments to the act were paramount. An evaluation completed
by participants was both congratulatory and constructive with most recommending
follow up and/or further action.
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