Personal Preferences
Decisions about medication should involve the person and respect their preferences.
- The person is left out of decision-making about medication or feels that their preferences are not being respected.
- The person is not given necessary information in a way they understand to help inform their decisions regarding medication.
- Where the person does not have capacity, the substitute decision-maker is not involved in decisions about medication.
- Ensure the person (or, if the person does no have capacity, their substitute decision-maker) is provided with relevant information prior to making decisions about medications.
- Ensure that the person’s Advance Care Directive and any other care planning documents are:
- up-to-date and reflect the needs and preferences of the person
- available to care staff and inform delivery of care including decisions about medication.
- Check in with the person (and others involved in decision-making relating to their care) that they have the information they need to make decisions and feel heard.
- Conduct routine audits to check that information about future medication and treatment preferences is available and accessible in the residential aged care facility.
Person-centred care
The person who is at end stage of life is central to decision-making. They must be involved in all decisions about their care and treatment. A person with decision-making capacity can decide whether to accept or refuse medication and other forms of medical treatment.
Individuals will have different views and preferences about whether and how to use medications. This may come from their cultural or faith traditions, or their personal beliefs and values.
People have the right to refuse treatment or medication
Dignity of risk refers to a person’s right to make their own decisions about their care and services, including making choices that involve some risks. A person has the right to refuse medical treatment (including medications) needed to keep them alive. Where this occurs, their decision should be respected and the treatment or medication withheld (not provided) or withdrawn (stopped), even if they will die without it. It is important that these choices are recorded in care documention and that medical staff are made aware when a person refuses treatment or medication.
Giving medication and treatment to a person against their wishes is an assault. It may also result in unwanted or non-beneficial treatment, and can cause distress to the person, their family and friends, and health professionals.
Preferences may be captured in Advance Care Directives and planning
The Aged Care Quality Standards require providers to undertake ongoing assessment and planning with residents to identify and address their current needs, goals and preferences. This includes advance care planning and end of life planning if the person wishes. It is important to know if the person has expressed any preferences regarding medication and treatment, for example, in an Advance Care Directve or other planning document, and that these are clearly recorded.
Others may support decision-making
Individuals may choose to involve their family, friends and/or health professionals to inform and assist their decision-making.
There may be a substitute decision-maker
If the person does not have decision-making capacity (their doctor would normally determine this), their substitute decision-maker can make decisions about medical treatment on behalf of the resident.