An algorithm for managing adults who refuse medical treatment in New South Wales

Cheng, Kylie; Wand, Anne; Ryan, Christopher; Callaghan, Sascha

doi:10.1177/1039856218758565

Cited by 4 publications

(9 citation statements)

References 5 publications

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“…In Australia, a range of laws exist to guide appointment of substitute decision-makers for adults unable to give consent. 25 , 41 As John was socially isolated with no informal substitute decision-maker, he was appointed a Public Guardian. A Public Guardian in New South Wales (NSW), the jurisdiction of this case, is a public official appointed by the Guardianship Division of the NSW Civil and Administrative Tribunal 42 with powers for substitute consent for health care and treatment for people with decision-making disabilities including, as in John’s case, authority to override the person’s objections.…”

Section: Resultsmentioning

confidence: 99%

“…Consent was given for the operation by the Medical Superintendent according to Australian Mental Health Laws. 41 Her distal radius fracture was managed conservatively.…”

Section: Resultsmentioning

confidence: 99%

“…The identified lack of capacity for treatment consent led clinicians to intervene in the patient’s best interests according to appropriate legal frameworks. 41 It is possible that other clinicians, recognizing the potential distress to the patient in compelling them to have the refused medical investigation or treatment, would have prioritized non-maleficence over beneficence. Which approach is right?…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, a supported decision-making approach (as opposed to the substitute-decision making approach adopted in these cases) may be at odds with other important human rights. 76 For example, without the application of relevant guardianship and mental health laws 41…”

Section: Human Rightsmentioning

confidence: 99%

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Navigating the Minefield: Managing Refusal of Medical Care in Older Adults with Chronic Symptoms of Mental Illness

O'Cionnaith¹,

Wand²,

Peisah³

2021

CIA

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The purpose of this case series is to illustrate the complexity of considerations across health (physical and mental), ethical, human rights and practical domains when an older adult with chronic symptoms of mental illness refuses treatment for a serious medical comorbidity. A broad understanding of these considerations may assist health care professionals in navigating this challenging but common aspect of clinical practice. Case Presentation: Three detailed case reports are described. Participants were older adults with an acute presentation of a chronic mental illness, admitted to a specialized older persons mental health inpatient unit (OPMHU) in an Australian metropolitan hospital. Significant comorbid medical issues were detected or arose during the admission and the patient refused the recommended medical intervention. Data extracted from patients' medical records were analyzed and synthesized into detailed case reports using descriptive techniques. Each patient was assessed as lacking capacity for healthcare and treatment consent and did not have relatives or friends to assist with supported decision-making. Multifaceted aspects of decision-making and management are highlighted. Conclusion:There are multiple complex issues to consider when an older adult with chronic symptoms of mental illness refuses treatment for serious comorbid medical conditions. In addition to optimizing management of the underlying mental illness (which may be impairing capacity to make healthcare decisions), clinicians should adopt a role of advocacy for their patients in considering the potential impact of ageism and stigma on management plans and inequities in physical healthcare. Consultation with specialist medical teams should incorporate multifaceted considerations such as potentially inappropriate treatment and optimum setting of care. Equally important is reflective practice; considering whether treatment decisions may infringe upon human rights or cause trauma.

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Section: Resultsmentioning

confidence: 99%

“…Consent was given for the operation by the Medical Superintendent according to Australian Mental Health Laws. 41 Her distal radius fracture was managed conservatively.…”

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Human Rightsmentioning

confidence: 99%

See 2 more Smart Citations

Navigating the Minefield: Managing Refusal of Medical Care in Older Adults with Chronic Symptoms of Mental Illness

O'Cionnaith¹,

Wand²,

Peisah³

2021

CIA

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show abstract

“…I’d like to congratulate Cheng et al on a valuable piece of work, 1 whilst cautioning readers in pursuing an avenue of ‘overriding objection’, which the article promulgates. Reference is made to the Guardianship Act 1987 (NSW) section 46(4); that a person responsible can disregard patient objection to treatment if there is ‘minimal or no understanding’ of the treatment, and the treatment will cause the patient ‘no distress’ or ‘some distress’ that is ‘reasonably tolerable and only transitory’.…”

mentioning

confidence: 99%

An alternative viewpoint to overriding treatment objection using s 46(4) – comment on Cheng et al.

Lamont

2018

Australas Psychiatry

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Algorithm for the use of the Guardianship Act, the Mental Health Act and the Public Health Act in emergency departments in New South Wales

Huber

Aguirrebarrena

Ryan

2021

Emerg Medicine Australasia

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Objective: To address frequently asked questions regarding the use of the Guardianship Act, the Mental Health Act and the Public Health Act within New South Wales EDs and present an algorithm to guide the use of this legislation. Methods: An ED-specific algorithm was developed for the use of the three pieces of legislation. Then an emergency psychiatrist and an emergency physician reviewed the algorithm with ED staff to understand its usefulness and where further detail was required. Frequently asked questions were collated. Results: Frequently asked questions are addressed with reference to the algorithm. Conclusion: This paper offers an algorithm that can be easily followed for use in EDs across New South Wales.

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An algorithm for managing adults who refuse medical treatment in New South Wales

Abstract: The algorithm provides a clear decision tree for clinicians responding to a patient refusing medical treatment in NSW.

Cited by 4 publications

References 5 publications

Navigating the Minefield: Managing Refusal of Medical Care in Older Adults with Chronic Symptoms of Mental Illness

Navigating the Minefield: Managing Refusal of Medical Care in Older Adults with Chronic Symptoms of Mental Illness

An alternative viewpoint to overriding treatment objection using s 46(4) – comment on Cheng et al.

Algorithm for the use of the Guardianship Act, the Mental Health Act and the Public Health Act in emergency departments in New South Wales

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