Advanced directive. Choice based on informed consent

摘要

The conflicting situation, which Parker et al. refer to, between patient autonomy and support for advanced planning directives and recommendations to doctors to make clinical decisions according to recognized clinical guidelines by the Australian Medical Association (AMA) may relate to the following.1 Government failure to define terms such as 'best interest' as a personal viewpoint. Not doing so allows for 'discretionary' interpretation.2 Definitions are integral to an evidence based approach to medical care and legislation, yet simple definitions cannot be agreed upon.3 'Trust' is integral to the doctor patient relationship, which is exemplified by informed consent to treatment or to non-treatment according to the patient's wishes expressed at the time of treatment or in any advanced directive.4 Informed consent ensures that the person/patient has been prospectively informed of their choices, so that an advanced care directive ought to be signed by a medical doctor whom the patient trusts, as if the person is signing a power of medical guardianship that the document in effect becomes, albeit in circumscribed circumstances in some jurisdictions, if and when it may be needed. The advanced care directive then becomes an extended arm of the doctor patient relationship and informed consent process that requires no further amendments. But not all States require a medical practitioner to witness the document to satisfy basic criteria that the person has considered other options and that their choice is not affected by health, social or other issues, which is why two persons, at least one of whom is a medical practitioner that the patient has trust in ought to witness the patient's signing of the document.