Dr Helen Tom, General Practitioner & Kathryn Cunning, Practice Nurse
General Practice plays a key role in Witnessing of Power of Attorney Forms Encouraging discussion re: End of Life Wishes Witnessing of Advanced Care Directives
Brought to our attention early 2009: 84yr old woman, living with her Son & DIL, in Bendigo Multiple health issues including: ◦ Diabetes Mellitus Type 2 ◦ Vascular Dementia ◦ Chronic Renal Failure
Developed Osteomyelitis with Rt 2 nd Toe amputation ◦ Prolonged hospital admission due to issues of guardianship ◦ Deemed not competent to make her own decisions ◦ VCAT hearing appointed her Grandson, who lived in Melbourne, her Guardian ◦ He transferred her to the Austin Hospital for more Acute Care ◦ Recognised the need for all patients to have Medical Power of Attorney & Advanced Care Planning.
A Clinic decision was made to include the discussion of Medical Power of Attorney & Advanced Care Planning, at all Health Assessments & Care Plans where relevant. Target Population : Over 75yr old patients in their Health Assessments MY ROLE: Discussion with the patient Witness of relevant documents Provision of Advanced Care Document
Medical Power of Attorney ◦ Less than10% of Over 75yr old patients had completed Medical Power of Attorney Advanced Care Directive o Less than 5% of Over 75yr old patients had completed an Advanced Care Directive
Seeking Legal Advice initially from OPA Over 75 Year Health Assessment Comprehensive Medical Assessments (CMA’s) GP Management Plans (GPMP & TCA) General Public TEMPLATES DEVELOPED: Over 75yr Health Assessment Advanced Care Directive
Medical Power of Attorney ◦ Over 95% of the Over 75yr old patients now have a completed Medical Power of Attorney Advanced Care Directive ◦ Less than 50% of the Over 75yr old patients have completed an Advanced Care Directive.
93 yo Woman ◦ Mild dementia ◦ Heart Failure ◦ Peripheral Neuropathy ◦ She is medically managed and has told her MPO that she does not want to be kept alive if fully demented. ◦ Can Medical POA ask her doctor to cease her heart medications when she can no longer make decisions for herself?
78 yo woman life long intellectual disability living in an aged care facility ◦ Facility policy is that everyone must have an ACD. In absence, the staff are advised in medical emergency to fully resuscitate ◦ The staff and doctor felt that full resuscitation would be a burdensome intervention. ◦ Her brother in Maryborough, who never visits, asked for full resuscitation in a medical emergency . He does not have MPOA. ◦ Do we need to contact her guardian to override his wishes or can the doctor and nurses make a decision?
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