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ADVANCE CARE DIRECTIVES ACT 2013 - SECT 36

ADVANCE CARE DIRECTIVES ACT 2013 - SECT 36

36—Health practitioners to give effect to advance care directives

        (1)         Subject to this Act, a health practitioner who is providing, or is to provide, health care to a person who has given an advance care directive and who has impaired decision-making capacity in respect of a decision that is required in relation to the health care

            (a)         must comply with a binding provision of the advance care directive that relates to health care of the relevant kind; and

            (b)         should, as far as is reasonably practicable, comply with a non-binding provision of the advance care directive that relates to health care of the relevant kind; and

            (c)         must, as far as is reasonably practicable, seek to avoid any outcome or intervention that the person who gave the advance care directive would wish to be avoided (whether such wish is expressed or implied); and

            (d)         must endeavour to provide the health care in a manner that is consistent with the principles set out in section 10.

Note—

This includes the provision of emergency medical treatment—see Division 5 of Part 2 of the Consent to Medical Treatment and Palliative Care Act 1995 .

        (1a)         Subsection (1)(a) does not apply in relation to a binding provision of an advance care directive to the extent that—

            (a)         the health practitioner reasonably suspects that the person has attempted suicide or self-harmed; and

            (b)         the health practitioner is of the opinion that the provision of health care is reasonably necessary to save the life of the person.

        (1b)         A health practitioner who, pursuant to subsection (1a), provides health care in contravention of a binding provision of an advance care directive must, as soon as reasonably practicable after doing so—

            (a)         make a written record setting out the information required by the regulations in relation to the provision of the health care; and

            (b)         provide a report in relation to the provision of the health care in accordance with the requirements set out in the regulations.

        (1c)         Subsection (1)(b) does not apply in relation to a non-binding provision of a kind referred to in section 19(1a).

        (1d)         Subsection (1)(c) and (d) do not apply in relation to a binding provision of a kind referred to in subsection (1a), a non-binding provision of a kind referred to in section 19(1a), or to health care of a kind referred to in subsection (1a)(b).

        (1e)         Without limiting subsections (1a), (1c) or (1d), but to avoid doubt, the effect of those subsections is as follows:

            (a)         a health practitioner may disregard a provision of a person's advance care directive that is a refusal of health care if—

                  (i)         the need for the health care arises out of the attempted suicide or self-harm of the person; and

                  (ii)         the health care is reasonably necessary to save the life of the person;

            (b)         in such a case, the health practitioner

                  (i)         may nevertheless decide to comply with the person's refusal of health care in their advance care directive and not provide such health care to the person; or

Note—

Such a decision would be subject to the health practitioner's usual professional standards.

                  (ii)         may, if authorised to do so under another Act or law, provide health care to the person despite the person's refusal of the health care in their advance care directive if, and only if, the health care arises out of the attempted suicide or self-harm and is reasonably necessary to save the life of the person;

Note—

Such Acts would include the Consent to Medical Treatment and Palliative Care Act 1995 and the Mental Health Act 2009 .

            (c)         nothing in those subsections operates to authorise the health practitioner to provide health care without being authorised to do so under the Consent to Medical Treatment and Palliative Care Act 1995 or the Mental Health Act 2009 or any other Act or law;

Note—

Those Acts operate to deem consent to have been given, or to dispense with the need for consent, in specified circumstances.

            (d)         the person's refusal of health care in their advance care directive (for example, in the case of a general "do not resuscitate" provision) would continue to apply in relation to any health care that does not arise out of the attempted suicide or self-harm, or that is not reasonably necessary to save the life of the person.

Example—

If the person were to need stitches for a non-life threatening laceration, the person's refusal of treatment would, even in the case of self-harm, continue to apply.

        (2)         Despite subsection (1), a health practitioner may refuse to comply with a provision of an advance care directive if the health practitioner believes on reasonable grounds that—

            (a)         the person who gave the advance care directive did not intend the provision to apply in the particular circumstances; or

            (b)         the provision does not reflect the current wishes of the person who gave the advance care directive.

Note—

This subsection does not, however, authorise a health practitioner to provide health care. If health care is to be provided, consent must be given in accordance with the Consent to Medical Treatment and Palliative Care Act 1995 —see, for example, Part 2A of that Act.

        (3)         Despite subsection (1), a health practitioner may refuse to comply with a provision of an advance care directive that specifies the kind of health care that the person who gave the advance care directive wishes to receive if such health care

            (a)         is not consistent with any relevant professional standards; or

            (b)         does not reflect current standards of health care in the State.

        (4)         Subsection (3) does not apply—

            (a)         to, or in relation to, a binding provision of an advance care directive; or

            (b)         if the specified health care comprises the withdrawal, or withholding, of health care to a person (including, to avoid doubt, the withdrawal or withholding of life-sustaining measures).

Example—

An example would be a "do not resuscitate" instruction in an advance care directive.

        (5)         For the purposes of the Health Practitioner Regulation National Law (South Australia) Act 2010 and the Health Practitioner National Law (South Australia) , and for any other Act declared by the regulations to be included in the ambit of this subsection, a contravention of this section will be taken to amount to unprofessional conduct.