Abstract
The SDM approach empowers patients and strengthens the person’s AD. It is particularly valuable at the time when the patients are formulating and setting down their wishes. Generally, SDM employed at the time the AD was made could address the concerns raised about the patient’s mental capacity and understanding of the consequences of the treatment refusal, as well as future changes that would impact upon the AD.
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Notes
- 1.
For example, Phillipa Malpas in Phillipa J Malpas “Advance directives and older people: ethical challenges in the promotion of advance directives in New Zealand” (2011) 37 J Med Ethics 285 at 287 suggested that in the context of a consultation between a doctor and a patient regarding an AD, discussions could include possible future scenarios and probable medical treatments, such as treatment outcomes, consequent burdens and benefits. Malpas also recommended that a more personal topic concerning the patient’s desire for control at the end-of-life could be broached at this stage.
- 2.
Nina A Kohn, Jeremy A Blumenthal and Amy T Campbell “Supported Decision-Making: A Viable Alternative to Guardianship?” (2013) 117 Penn State Law Review 1111 at 1123. Kohn, Blumenthal and Campbell suggested that “SDM relationships may also occur in the context of ‘circle of support’ or a ‘microboard.’ Such circle of support consists of “a group of people, typically family members and friends, who meet regularly with a person with a disability to help that person formulate and realize his or her hopes or desires.”
- 3.
Atul Gawande “Letting Go: What should medicine do when it can’t save your life?” (2 August 2010). http://www.newyorker.com/magazine/2010/08/02/letting-go-2. Accessed 10 July 2016.
- 4.
Some examples include Royal Australasian College of Physicians RACP Submission: Draft Advance Care Directive DIY Kit (March 2014) at 2 where the RACP favoured the involvement of doctors and carers in helping patients and families understand and complete AD forms. Other healthcare organisations recommending doctors’ involvement include New Zealand Health and Disability Commissioner “Advance Directives in Mental Health Care and Treatment”. http://www.hdc.org.nz/publications/resources-to-order/leaflets-and-posters-for-download/advance-directives-in-mental-health-care-and-treatment-(leaflet). Accessed 9 June 2016; American Medical Association “Advance Directives”. https://www.ama-assn.org/delivering-care/advance-directives. Accessed 9 November 2017; ABA Commission on Law and Aging “Myths and Facts about Health Care Advance Directives”. http://www.americanbar.org/content/dam/aba/uncategorized/2011/2011_aging_bk_myths_factshcad.authcheckdam.pdf. Accessed 8 June 2016; NZMA Member Advisory Service Information Sheet “Advance directive information and sample form”. https://www.nzma.org.nz/__data/assets/pdf_file/0018/77040/Advance-Directive_sample-forms.pdf. Accessed 8 June 2017; B Pace “Decisions about End-of-Life Care” (2000) 284 JAMA 2550; B Pace “Advance Directives for End-of-Life Medical Decisions” (2000) 283 JAMA 1518.
- 5.
Note that while some people would favour a greater role for families in supporting them during the discussion process, the presence of families may present some dangers in the sense that the patient may be reluctant to express their decisions genuinely for personal reasons. See also J Craigie “A Fine Balance: Reconsidering Patient Autonomy in Light of the UN Convention On The Rights Of Persons With Disabilities” (2015) 29 Bioethics 398 at 402, 403. In this article, Craigie identified the challenge of effectively exercising autonomy in the decision-making process while receiving support and guarding against attempts at potential influences that might undermine the freedom to decide.
- 6.
Right 7(4)(c) of the Code of Rights.
- 7.
HE v A Hospital NHS Trust & AE (by her litigation friend the Official Solicitor) [2003] EWHC 1017 (Fam).
- 8.
Ibid, at [35].
- 9.
Re T [1992] EWCA Civ 18 at [45].
- 10.
Re T [1992] EWCA Civ 18 at [15].
- 11.
Nina Kohn, Jeremy Blumenthal and Amy Campbell “Supported Decision-Making: A Viable Alternative to Guardianship?” (2013) 117 Penn State Law Review 1111–1114, 1128; Nina Kohn and Jeremy Blumenthal “A critical assessment of supported decision-making for persons aging with intellectual disabilities” (2014) 7 Disability and Health Journal S40–S43; Terry Carney “Clarifying, Operationalising, and Evaluating Supported Decision Making Models” (2014) 1 Research and Practice in Intellectual and Developmental Disabilities 46.
- 12.
Ibid, at 1154.
- 13.
Ibid, at 1137, 1139, 1145.
- 14.
Mary Donnelly, ‘Best Interests In The Mental Capacity Act: Time To Say Goodbye? 2016 24(3) Medical Law Review 318–332.
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Chan, H.Y. (2018). A Supported Decision-Making Model for Advance Directives. In: Advance Directives: Rethinking Regulation, Autonomy & Healthcare Decision-Making. International Library of Ethics, Law, and the New Medicine, vol 76. Springer, Cham. https://doi.org/10.1007/978-3-030-00976-2_5
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