• Thu. Aug 11th, 2022

Children can decide on their medical treatment under Victoria’s single advance directive laws


We all fear a time when we might lose the ability to decide which medical treatments to accept or refuse. This is why Australian governments have encouraged advance care planning, which involves discussing and expressing your preferences about what kind of medical care you would or would not want in a situation where you do not have the mental capacity to. to take decisions.

Writing an advance care directive is part of the planning process, but a directive means that the person’s preferences must be respected by law. All states and territories have different laws that allow adults to develop advance care plans or guidelines. In Victoria, new legislation will come into effect in March 2018, creating clear obligations for healthcare professionals to comply with advance directives.

A globally unique aspect of the Victoria Medical Treatment Planning and Decisions Act, 2016 is that it allows children to make advance directives. In the Netherlands, children aged 12 and over can make advance decisions to request euthanasia if their parents consent. Advance directives in palliative care have also been used in the United States, but they have no legal authority, simply the status of “moral suasion”.



Read more: Take control of the end of your life: What you need to know about advance care directives


In Victoria there will be no age limit, so anyone can issue a directive as long as they are competent to do so. This means that a person can understand the nature of the treatment for which they are making decisions and the potential results if the advance care directive is followed.

At first glance, it may seem irresponsible to give children the power over their future medical treatments, which in many cases is a matter of life and death. But respecting the autonomy of young people in their choice of care is important. It encourages their commitment to treatment, gives a voice to their values, and provides a sense of empowerment at a time when illness may diminish their control over events.

Are the children capable?

While teens are more likely to engage in risky behaviors and be influenced by the opinions of their friends, this is less likely to affect their decisions about hospital treatment. A recent study has shown that children around the age of 12 have the competence to make medical decisions. But of course, it depends on the type of decision made.

A decision involving risky and complex treatment would require a high level of skill. Yet children with terminal and chronic illnesses will know a lot about their illnesses and the impact of treatment. In 2008, a 13-year-old English girl refused to consent to a heart transplant after having undergone six operations in two years. She showed her case manager and the hospital that she could make an informed decision and that she had weighed the risks of the operation and the potential benefits (although she later changed her mind. ).

Children with terminal and chronic illnesses will know a lot about their illnesses and the impact of treatment.
from shutterstock.com

We might consider it appropriate to protect young people from choices considered harmful and contrary to their best interests. Ethical dilemmas usually arise when children disagree with what doctors suggest. The courts have overturned the decisions of competent minors to refuse treatment in cases where such refusal would result in permanent disability or death.

For example, in Sydney, a 17-year-old boy refused to receive blood transfusions because of his beliefs as a Jehovah’s Witness. The judge overturned the child’s decision after considering preserving his life was more powerful than upholding the boy’s faith.

A similar case occurred in England in 1993. Here, a 15-year-old boy, whom the judge called “intelligent”, refused a blood transfusion as part of treatment for leukemia on religious grounds . The judge found him incompetent to make such a decision because the boy could not understand the pain he would suffer, the fear of dying and the distress caused to his family.



Read more: When parents disagree with doctors over a child’s treatment, who should have the final say?


Victoria’s new laws will mean that decisions made before the loss of capacity must be followed, so the directive cannot be overturned. But there are strict safeguards and requirements for an advance care directive.

It must be drawn up in English, signed and certified. At least one of the witnesses must be a doctor who must certify that the person appears to have the capacity to make decisions and understands the effect of statements made. In the case of a child, the doctor can help him to appreciate the implications of the advance directive and ensure that it is consistent and applicable in practice.

When a child could write a directive

Advance directives can be formulated for any future treatment, and not just for situations where the person is terminally ill or has an illness that could shorten their life. However, minors are likely to write advance directives to inform their end-of-life care.

An advance directive comes into effect when the child becomes unable to make decisions due to his illness. Victorian law provides that if a child has made a valid advance directive in which they have included instructions to refuse a particular medical treatment, such as dialysis or chemotherapy, a healthcare professional should not provide that treatment.

The child’s wish for prior autonomy is respected, even though those who care for them may not believe that this decision is in their best interests.

The law also allows for a values ​​directive, which is different from an educational directive. The Values ​​Directive records a person’s preferences and values ​​for future treatment. A young person with cancer may place more importance on remaining quality of life and a dignified death than undergoing painful treatment. A values ​​guideline means that the medical treatment decision maker should consider treatment based on the patient’s values.

Parents want to protect their children, and healthcare professionals want to do the best they can for their patients. Advance directives should be drafted in collaboration between the child, health professionals and, ideally, parents. This will help to understand the possible treatment options, their advantages and disadvantages, and the impact of refusing certain treatments, resulting in a meaningful and effective advance decision.


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