Lyla Lindsey
In Western Australia, the legality of 'not for resuscitation' (NFR) or 'do not resuscitate' (DNR) forms is unclear, and there is a lack of legislation regarding NFRs, especially when a patient is unable to make decisions for themselves. Each hospital in Western Australia may have its own NFR form, developed independently with varying formats and requirements for signatures. These NFR forms are typically filled out by doctors for patients who lack decision-making capacity, such as those with advanced dementia. However, there are concerns about the validity of these forms outside of hospital settings. In contrast, Advance Health Directives, which allow individuals to make decisions about their future care, are legally recognised in Western Australia and can be used to refuse consent for life-sustaining treatments, including cardiopulmonary resuscitation (CPR).
| Characteristics | Values |
|---|---|
| Name | Not for Resuscitation (NFR) form |
| Location | Western Australia |
| Legality | Unclear |
| Users | Hospitals, patients, paramedics |
| Purpose | To inform health care teams that in the event of a cardiac arrest, cardiopulmonary resuscitation will not be conducted |
| Requirements | Varies by hospital, but may include family consent and signatures from one or more doctors |
| Validity | May be valid outside of hospitals, but legality is unclear |
| Revocation | Can be revoked orally, in writing, or through other means of communication |
| Substitute Decision-makers | Involved in the decision-making process, formerly appointed by the patient or by default mechanisms specified in state legislation |
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What You'll Learn
Legality of 'Do Not Resuscitate' (NFR) forms in Western Australia
In Western Australia, there is a lack of clear legislation regarding the legality of 'Not for Resuscitation' (NFR) or 'Do Not Resuscitate' (DNR) forms, especially when a patient is unable to make decisions for themselves. This has raised questions among paramedics and ambulance staff about the validity of these forms outside of hospitals, as they are often hospital-developed forms that differ from the state government's 'advanced health directive' form.
Western Australia's laws on capacity and consent to medical treatment allow individuals to make an Advance Health Directive. This legal document enables individuals to consent or refuse consent to any treatment, including medical or surgical procedures, palliative care, life-sustaining treatment, and dental treatment. It is important to note that an Advance Health Directive cannot be used to demand treatment that is not medically indicated. This directive takes priority over decisions made by an Enduring Guardian, who is appointed by an individual to make treatment decisions when they lack the capacity to do so.
The legality of NFR or DNR forms in Western Australia is further complicated by the varying formats and requirements of different hospitals. Some hospitals require the agreement of family members and multiple doctors, while others only need the approval of a single doctor. Additionally, some forms are labelled "for this admission only," raising questions about their validity outside of specific hospital admissions.
To address these concerns, Western Australia has produced a Guide to Making an Advance Health Directive. While the legislation encourages individuals to seek legal or medical advice, it does not provide clear guidelines for paramedics and healthcare professionals encountering NFR or DNR forms that differ from the Advance Health Directive. This lack of standardised forms and understanding of the law may lead to confusion and potential legal consequences for healthcare providers.
To summarise, the legality of NFR or DNR forms in Western Australia is complex and requires further clarification from legislation and standardised practices. While Advance Health Directives are recognised, the validity of hospital-developed NFR or DNR forms outside of specific admissions or hospital settings remains uncertain. Standardised guidelines and improved legal understanding among healthcare professionals are necessary to ensure patient autonomy and avoid potential legal repercussions.
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Who can initiate an NFR form
In Western Australia, a person can initiate a Do Not Resuscitate (DNR) form, also known as a 'Do Not Attempt Resuscitation' (DNAR) or 'Do Not Attempt Cardiopulmonary Resuscitation' (DNACPR) form, if they have what is referred to as 'decision-making capacity'. This means they can understand the benefits and risks of cardiopulmonary resuscitation (CPR) and communicate their decision consistently.
If a patient lacks decision-making capacity, a substitute decision-maker can initiate a DNR form on their behalf. This could be a guardian, an enduring power of attorney, or a person appointed by the State Administrative Tribunal (SAT). It is important to note that the substitute decision-maker must make decisions in the patient's best interests, taking into account their values and beliefs.
In the absence of a substitute decision-maker, an 'implied consent' process may be followed. This involves a DNR decision being made by a medical practitioner in consultation with the patient's family or carers. This process should only be undertaken if the patient's condition is irreversible and they are expected to die soon.
Additionally, in Western Australia, a person can make an advance health directive, also known as an 'advance care plan' or 'advance decision', to document their preferences for future care, including resuscitation attempts. This allows individuals to outline their wishes regarding CPR and other life-sustaining treatments in the event that they lose decision-making capacity.
It is important to emphasise that the initiation of a DNR form should involve a collaborative discussion between the patient, their family, and healthcare professionals. This ensures that the patient's values and preferences are respected, and that all parties understand the implications of the decision.
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NFR forms and Advance Health Directives
In Western Australia, there are questions and concerns regarding the legality of 'not for resuscitation' (NFR) forms. Paramedics and ambulance staff frequently encounter NFR forms from hospitals when transporting patients home or between facilities. Each hospital in Western Australia may have its own NFR form, developed independently with varying formats and requirements for authorisation, such as the number of signatures needed. These NFR forms are typically completed by doctors for patients lacking decision-making capacity, such as those with advanced dementia.
The legality of NFR forms outside of hospitals is uncertain, as they differ from the state government's advanced health directive forms. Advance Health Directives (AHDs) are legally recognised in Western Australia and allow individuals to make specific treatment decisions, including consenting or refusing medical, surgical, palliative, or life-sustaining treatments. AHDs cannot be used to demand treatment that is not medically indicated. To be valid, AHDs must be witnessed by two individuals over 18, one of whom is authorised to take declarations, such as a Justice of the Peace. While not mandatory, individuals are encouraged to seek legal or medical advice regarding their AHDs.
AHDs take precedence over decisions made by an Enduring Guardian, appointed through an Enduring Power of Guardianship. Individuals can revoke their AHD at any time without formal requirements, provided they communicate their decision orally, in writing, or through other means. However, health professionals may deviate from an AHD if circumstances arise that the individual could not have reasonably anticipated when creating the directive.
While NFR forms are commonly used in Western Australia, their legal status, particularly outside of hospitals, remains unclear and distinct from AHDs. In contrast, AHDs provide a comprehensive and legally recognised framework for individuals to outline their end-of-life care preferences, values, and substitute decision-makers.
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Substitute decision-makers
In Western Australia, a person with decision-making capacity can record their future health and personal care wishes in an Advance Health Directive (AHD). This is a legal document that outlines an individual's preferences, values, and instructions regarding medical treatments. It is important to note that an AHD is not the same as a 'Do Not Resuscitate' (DNR) or 'Not for Resuscitation' (NFR) order, which specifically addresses resuscitation preferences.
When creating an AHD, individuals can appoint a substitute decision-maker, also known as an enduring guardian, to act on their behalf if they become unable to make decisions for themselves. This substitute decision-maker is typically a trusted individual, such as a family member or friend, who is expected to make choices that align with the individual's wishes and best interests. It is recommended that individuals choose someone they are confident will make decisions based on their values and preferences. Additionally, a second person can be chosen as an alternate decision-maker, who will step in if the primary substitute decision-maker is unable to fulfil their role.
The process of appointing a substitute decision-maker varies across Australian states and territories. In Western Australia, individuals can utilise an Enduring Power of Guardianship, a legal document that authorises the enduring guardian to consent to or refuse treatment on the individual's behalf. It is crucial to specify the functions and responsibilities granted to the enduring guardian in this document. Multiple enduring guardians can be appointed, but they must act jointly.
It is important to note that an Advance Health Directive can be revoked if an individual changes their mind or regains decision-making capacity. However, the revocation must be communicated clearly, either orally, in writing, or through other means. If an individual wishes to change their AHD, they should cancel the previous version and create a new one, ensuring that all relevant parties are informed of the update.
In the context of 'Do Not Resuscitate' orders, substitute decision-makers play a crucial role in honouring the wishes of individuals who are unable to make decisions for themselves. Their involvement in the decision-making process is supported by legislation and dispute resolution mechanisms in Western Australia and other states. It is important to seek legal advice to understand the specific requirements and laws governing substitute decision-makers in Western Australia.
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Legal consequences of ignoring an NFR form
In Western Australia, there is limited information on the legislation regarding 'Not for Resuscitation' (NFR) forms, particularly when a patient is unable to make decisions for themselves. NFR forms are usually filled out by doctors on behalf of patients who are not competent to make decisions, such as those with advanced dementia.
There are concerns about the legal validity of these forms outside of hospitals, as they are developed by individual hospitals and differ from the 'advanced health directive' form provided by the state government. The advanced health directive form allows individuals to make decisions about their future treatment, including refusing consent to life-sustaining treatment, if they are no longer capable of making those decisions themselves.
In the case of an NFR form being ignored, for example, due to its absence, perceived incompleteness, or doubts about its legal validity, there is a possibility that the responder could be guilty of assault for administering cardiopulmonary resuscitation (CPR). However, it is important to note that no one has been sued for attempting to provide emergency assistance.
Additionally, doctors play a critical role in assessing the validity of NFR orders and making decisions about resuscitation treatment. If a doctor assesses that further treatment is futile, it is in the patient's best interest to honour that decision.
To summarise, while the legal consequences of ignoring an NFR form in Western Australia are not entirely clear, it is essential to respect the wishes of the patient, their substitute decision-makers, and the medical professionals involved in their care.
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Frequently asked questions
A 'do not resuscitate' (NFR/DNR) form is a document that informs a health care team that cardiopulmonary resuscitation will not be conducted in the event of cardiac arrest.
The patient, their agent or guardian, and senior medical and nursing staff are all involved in the decision-making process. Doctors play a critical role in assessing the validity of the form.
It is unclear if these forms are legally valid outside of a hospital as they are hospital-developed and differ from the 'advanced health directive' form available from the state government.
Yes, a person can revoke an Advance Health Directive (the statutory name for a 'do not resuscitate' form) orally, in writing, or in some other manner. There are no formal requirements for revocation.
