Comment Template. Punctuation and layout will be finalised after the consultation and review process.

Transcription

1 Comment Template The Office of the Chief Health Officer would appreciate your feedback on the content and language in the documents: 1. DRAFT NSW Health Advance Care Directive Template 2. DRAFT Information Booklet. Punctuation and layout will be finalised after the consultation and review process. The comment template is set out in sections which correlate to the relevant sections in each document. Please add more lines as required. Feedback from NSW Health Pillars, Local Health Districts and Specialty Networks must be endorsed by the relevant Chief Executive. Closing date: Friday 29 April 2016 Enquiries: Ms Jennifer Gillott Senior Policy and Project Officer Office of the Chief Health Officer NSW Ministry of Health T: E:

2 Name: Amelia Christie Position: Manager, Research & Advocacy Organisation: Combined Pensioners & Superannuants Association of NSW Inc. Phone: Submission endorsed by Chief Executive: Date submitted: 29/4/2016 DOCUMENT 1: DRAFT ADVANCE CARE DIRECTIVE TEMPLATE Please add more lines as required SECTION 1 INTRODUCTION 1 The instructions for filling it out should come before the note to health professionals. While recognising that the definition is provided in the information booklet, a short definition of what an advance care directive is should be placed at the beginning of the document. It should also be made clear how it differs from a will (this is something which we find can be confusing among some CPSA constituents when discussing later life planning, particularly those who haven t heard of an ACD before). CPSA is concerned that there is no requirement to have it signed by the person writing it. Without the requirement to have it signed by the individual, many older people will be very sceptical of the process and wish to have none at all as they will be concerned that it could be tampered with without a need for a signature to denote a change. Obviously, signatures could be exempt for people with certain disabilities but on the whole CPSA believes that a signature should be required. It is counter intuitive that throughout the document writers are required to sign when they do not wish to complete a section, but not to verify that these are in fact their wishes. Not requiring a witness of the signature is problematic. CPSA is supportive of such documents not requiring a legal witness, but a witness who is not their nominated power of attorney or enduring guardian should be privy to the signing of the document. CPSA has concerns about oral options being available. While seeing the merit of this for some people, it needs to be specified who this needs to be told to, and how it can be verified that it is in fact the wishes of the person should they no longer have the capacity to make their treatment preferences known. SECTION 2 YOUR DETAILS AND THE PEOPLE YOU WANT INVOLVED IN DECISIONS 2-3 This is clear and concise. An added definition of what an enduring guardian is and how someone can appoint one would be worthwhile here. SECTION 3 PERSONAL VALUES 4 This section is very vague and should not be placed ahead of medical directions.

3 Some of the examples should be reworked to make them more appropriate/likely to be more relevant to more people. Offering the example, I do not want flowers in my room before asking about CPR etc. trivialises the importance of making an advance care directive. There is an error in the first line, it should read I do not wish to complete section 3 (rather than 2). This also occurs in upcoming sections where they are one number behind in the first line. 7 The questions on this page are worthwhile, CPSA suggests that the words for the first question on this page read at the end of my life, my preference is to be cared for... with the answer options given remaining the same.

4 SECTION 4 MEDICAL DIRECTIONS 9 This section should feature at the beginning of the document. Error at the beginning. It should read section 4 (not 3), although it should be even earlier in the document. It is CPSA s opinion that having this section as optional defeats the purpose of an advance care directive. People should be able to ignore the parts they don t wish to answer but medical directions should not be optional. The specific questions asked are not comprehensive or clear, and often too open ended. Specific scenarios should be given and people should respond accordingly (with the option for further comment if they wish). Please see our comment about Queensland s template under general comments which explains this in more detail. SECTION 5 SPECIFIC REQUESTS FOR TISSUE, ORGAN AND/OR BODY DONATION 12 (no page number written on the page itself) This is worthwhile including in the document. CPSA would like to see the signature, witness section and review date which appears at the end of this page on all pages. GENERAL COMMENTS Queensland Health s advance care/health directive is far more comprehensive and easy to fill out and follow and CPSA recommends that NSW Health adopt something similar. CPSA hears from people who are already using this document in NSW and contact us to find out whether it will be accepted here (it should be but people are still concerned that it might not be by hospital staff). It is also a document that geriatricians seem to be referring people to. Rather than reinvent the wheel with a different document it would be great if NSW Health could offer something very similar with NSW Health branding. Queensland s document clearly spells out scenarios and what they entail (such as artificial feeding and hydration), allows people to specify people who they don t wish to be consulted as well as those which they do. This is important, particularly if they wish to exclude particular family members from being consulted or informed about their treatment. The witness section in the Queensland template is also worth emulating, although CPSA believes that a witness should not need to be a Justice of the Peace or lawyer and that a witness should simply need to be a member of the public who does not hold an enduring guardian or power of attorney over the person, nor be a close relative or carer (paid or otherwise). Queensland s advance health directive form can be found here: data/assets/pdf_file/0011/269408/advance-health-directive- Form_Form-4.pdf

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6 DOCUMENT 2: DRAFT INFORMATION BOOKLET Please add more lines as required SECTION 1 INTRODUCTION SECTION 2 ABOUT ADVANCE CARE DIRECTIVES SECTION 3 PREPARATION SECTION 4 SUBSTITUTE DECISION MAKERS IN NSW 5 This section is important, particularly spelling out who is a person responsible and that this terminology replaces next of kin. It would be good if a definition of power of attorney was included here and an explanation of the difference between it and enduring guardianship. This is something that members of the public can be confused about. CPSA has also been alerted to instances where people have conflated executors with enduring guardians so making the definitions as clear as possible is very important.

7 SECTION 5 WHEN AN ADVANCE CARE DIRECTIVE APPLIES 6 Regarding the section when is my Advance Care Directive valid? CPSA has reservations about how a treating doctor can be sure that it was made voluntarily, or indeed even by the person themselves, if no signature or witness is required. SECTION 6 OTHER FREQUENTLY ASKED QUESTIONS 7 This section is good, particularly the comment about wills (which CPSA believes should also be on the ACD form itself) and the comments about euthanasia and interstate ACDs. These are questions that CPSA fields about planning ahead documents. GENERAL COMMENTS **Please submit completed comment template to acp@doh.health.nsw.gov.au by close of business Friday 29 April 2016.