Medico-legal stuff

Question 1

how do we assess for a mature minor?

Answer 1

gilick competency test

Question 2

If a person cannot consent, or lacks capacity to make decisions about their own medical care, then another person must make decisions on their behalf. Who is this person? List in hierarchical order

Answer 2

1. Power of attorney (medical) appointed by patient
2. agent appointed by VCAT
3. enduring guardian (specified medical) appointed by patient
4. patient’s spouse or domestic partner
5. patient’s primary carer
6. Patient’s family members including immediate children/parents etc

Question 3

what is an enduring power of attorney?

Answer 3

EPOA is a person who is nominated by a patient before the patient loses their capacity to make informed decision. This nominated person will then make decisions based on the patient’s behalf on financial/legal matters or medical matters.

note that there is a separate enduring power of attorney for medical matters and a separated enduring power of attorney for financial matters

Question 4

what is the difference between enduring and general power of attorney

Answer 4

general power of attorney ceases to operate in the event that the patient loses decision making capacity, whereas an enduring power of attorney ‘endures’ past this point

Question 5

what is a supportive power of attorney?

Answer 5

designed to promote the rights of people with disability to be supported to make their own decisions about things that affect them

Question 6

what is an advanced care plan?

Answer 6

patient documents their future health treatment wishes in a ‘living will’. In this they can dictate no resuscitation or the type of medical treatment they want. they however can’t refuse palliative care management.

Question 7

can a patient with dementia drive?

Answer 7

yes in its early stage. Anyone with a diagnosis of dementia must tell VicRoads. VicRoads will then monitor them until the point where they are no longer deemed capable of driving due to their illness.

Question 8

how might we assess an elderly patient’s capacity to drive?

Answer 8

on hx:
Any previous accidents? What sort of car do they drive? When do they drive? Where do they drive?

on ex:
MMSE/visual assessment; gold standard is on-road driving assessment with occupational therapist.

Question 9

what do you do if you believe treatments desired by the patient’s family are not in the patient’s best interest?

Answer 9

Doctors are not obliged to give treatment if they deem that it will be futile/or not to the patient’s best interests, and that palliation would be preferred.

You can get a second medical opinion if required.

Question 10

who might a medical professional call if they do not know what to do regarding consent/capacity for decision making?

Answer 10

OPA

Office of the Public Advocate hotline

Question 11

what is different about an enduring power of attorney (medical) and an enduring guardian (specified medical)?

Answer 11

enduring power of attorney (medical) acts on the patients behalf after they lose capacity for matters regarding their medical treatment. The EPOA can even refuse medical treatment on their behalf.

an enduring guardian who has been specified for medical treatment can only play a limited role in certain medical scenarios. So for example, they have NO role in refusing treatment/pregnancy termination/treatment that results in infertility etc.

Question 12

what do you need to do if you suspect a patient’s EPOA/NOK is not acting in the best interests of the patient, or is not genuine/sincere in making decisions on the patient’s behalf?

Answer 12

contact OPA and may need VCAT to step in.

Question 13

what is different between a community treatment order and inpatient treatment order?

Answer 13

a CTO is made for a patient to be receiving treatment in the community for up to 12 months if they are over 18yrs

an ITO is made for a patient to receive treatment in an inpatient setting for up to 6 months if they are over 18 yrs

Question 14

who consists of a medical tribunal?

Answer 14

usually lawyer, psychiatrist +/- other doctors, community members

Question 15

can a person who has had a stroke/tia drive immediately after the event?

Answer 15

No.

Patient who have had a stroke cannot drive for at least 1 month post stroke (or 3 months if commercial driver)

Patient who have had a TIA cannot drive for at least 1 week post TIA

Question 16

how might we address the question of a patient who has had a stroke, and wants to drive again?

Answer 16

1. Advise that patient should not drive for at least a month after the stroke.
2. Explain which symptoms e.g. inattention, visuospatial defects, weakness may impede on driving ability
3. Let patient know that they are legally required to let Vicroads know about the stroke
4. If they really want to drive after the 1 month off, they can have a conditional driving license so long as they have got medical approval (medically fit to drive), pass an off road test, and an onroad OT driving assessment.
5. Give written information about returning to driving.
6. Monitor for depressive symptoms as loss of driving may be a form of loss of independence for the patient

Question 17

4 criteria for involuntary admission under MHA?

Answer 17

1. you have mental illness.
2. Because you have mental illness, you need immediate treatment to prevent:
   - serious deterioration in your mental or physical health, or
   - serious harm to you or to another person.
3. You will get immediate treatment if you are on a temporary treatment order or treatment order.
4. There are no less restrictive means, reasonably available, for you to get the treatment that is needed.

Question 18

what are the three forms of compulsory treatment under the MHA?

Answer 18

1. assessment orders – made by a registered medical practitioner or a doctor to allow an authorised psychiatrist to examine you
2. temporary treatment orders – made by an authorised psychiatrist for a maximum of 28 days
3. treatment orders – made by the Mental Health Tribunal. They can only be made if you are already on a temporary treatment order.

Question 19

Define euthanasia?

Answer 19

Euthanasia is defined as a deliberate act with the intention of ending a person’s life in the context of serious illness.