From 1 March 2024, health practitioners are required to record and report any instances of life sustaining medical treatment provided in contravention of a binding refusal in a person’s Advance Care Directive.

The Providing health care in contravention of an Advance Care Directive binding refusal in the case of suicide or self-harm fact sheet (PDF 212KB) provides clear information and instruction about what health practitioners should do in these circumstances.

In certain situations, involving reasonably suspected suicide or self-harm, a health practitioner may provide life-sustaining treatment even if it goes against a person's binding refusal stated in their Advance Care Directive. This provision has been in place through the Advance Care Directives Regulations since 2019, but has now been formalised as part of the Act following a recommendation by Professor Wendy Lacey in her review of the Act in 2019. When this happens, health practitioners are required to follow the legal requirements for reporting. Here's what you need to know:

The situation

If you, as a health practitioner, reasonably suspect that a person has attempted suicide or self-harmed, and you believe that providing life-sustaining treatment is necessary to save their life, you may provide the treatment even if the persons Advance Care Directive has a binding refusal of this treatment. It is important to note that if a health practitioner decides to provide medical treatment, they still need consent, either by obtaining it under the Consent to Medical Treatment and Palliative Care Act 1995, or by way of some other statutory authorisation.

Reporting obligation

After providing the treatment in such a situation, you must take the following steps as soon as reasonably practicable:

  1. Written record: Make a detailed record in the patient's medical record that includes all the information required by the regulations regarding the provision of the health care.
  2. Report: provide a report about the provision of the health care in accordance with the requirements set out in the regulations.

Compliance

It is essential to comply with these reporting requirements to ensure that all legal obligations are met.

Legal framework

Please note that this action is guided by specific legal provisions, including the Advance Care Directives Act 2013, and the Advance Care Directives Regulations 2014.

Criteria

To comply with making a report under Regulations, the following criteria must have been met before proceeding with making a written record and making a report:

  1. The patient had a valid Advance Care Directive
  2. The patient's Advance Care Directive contained binding refusal/s of health care
  3. The patient's binding refusal/s of health care related to life sustaining treatment
  4. The health practitioner had reasonable grounds to suspect that the person had attempted suicide or engaged in self-harm.
  5.  The health practitioner provided life-sustaining treatment because they believed, in their professional judgement, that it was reasonably necessary to save the person's life. The situation was genuinely life-threatening.
  6. The treatment provided was directly related to addressing the life-threatening condition resulting from the suspected suicide or self-harm. It did not include any unnecessary or unrelated medical procedures.

If the above criteria have been met, please progress to: