Week 5 - Prerequisite knowledge

Question 1

What does the Medical Treatment Planning and Decisions Act 2016 (MTPD Act) require before treatment?

Answer 1

Valid consent

Applies to all registered health professionals; exceptions in emergencies.

Question 2

Decision-making capacity is _______ and _______.

Answer 2

decision-specific; time-specific

A person must be able to understand, retain, weigh, and communicate a choice.

Question 3

If a person has capacity, where does consent come from?

Answer 3

The person

If absent, follow Advance Care Directive (ACD) and/or Medical Treatment Decision Maker (MTDM) hierarchy.

Question 4

What are the two parts of the Advance Care Directive (ACD) in Victoria?

Answer 4

• Instructional directive
• Values-based directive

Instructional directives are legally binding; values-based directives must be considered.

Question 5

What is the role of an MTDM?

Answer 5

Decide when the person lacks capacity

The person nominates who will make decisions on their behalf.

Question 6

The Victorian Voluntary Assisted Dying (VAD) Act 2017 allows access for what type of individuals?

Answer 6

Eligible, competent adults

Must meet strict criteria and undergo a multi-step request/assessment.

Question 7

What is required for medication storage under the VAD Act?

Answer 7

Locked box

Unused medication must be returned by a contact person within 15 days after death.

Question 8

How is the cause of death recorded under the VAD process?

Answer 8

Underlying disease/condition

Not recorded as the VAD process itself.

Question 9

What are the four elements of decision-making capacity under the MTPD Act?

Answer 9

• Understand information
• Retain it long enough to decide
• Use/weigh benefits and burdens
• Communicate a choice

These elements are essential for assessing an individual’s ability to make informed decisions regarding their medical treatment.

Question 10

When can treatment proceed without consent under the MTPD Act?

Answer 10

• In an emergency to save life
• Prevent significant harm or severe distress
• When treatment is urgently required (≈ within 4 hours)

This provision ensures timely medical intervention in critical situations.

Question 11

Who provides consent if the person has decision-making capacity?

Answer 11

The person themself (direct consent)

Direct consent is fundamental when the individual is capable of making their own decisions.

Question 12

When capacity is absent, what documents/structures guide decisions?

Answer 12

• The person’s Advance Care Directive
• Medical Treatment Decision Maker (MTDM) hierarchy

These documents help ensure that decisions align with the individual’s wishes and best interests.

Question 13

Victorian ACD: which part is legally binding?

Answer 13

The instructional directive

This part contains specific treatment instructions that must be followed.

Question 14

Victorian ACD: which part is not legally binding but must be considered?

Answer 14

The values-based directive

This part outlines the individual’s values, goals, and preferences regarding treatment.

Question 15

Who can make decisions as an MTDM and when do they act?

Answer 15

A person appointed by the patient; they act only when the patient lacks capacity for the decision

This ensures that decisions are made by someone trusted by the patient.

Question 16

List the Victorian default MTDM hierarchy when no one is appointed.

Answer 16

• Spouse/partner
• Primary carer
• Oldest adult child
• Oldest adult parent
• Oldest adult sibling
• Office of the Public Advocate (for significant treatment)

This hierarchy establishes a clear order for decision-making authority.

Question 17

Who must sign/witness a Victorian ACD when the person has capacity?

Answer 17

• The person
• A doctor
• Another adult independent witness (not a beneficiary or named in a Will)

This requirement ensures the validity and authenticity of the Advance Care Directive.

Question 18

Where should an ACD be stored and flagged in healthcare records?

Answer 18

• In the legal/medical record (paper + scanned to EMR)
• With an alert/flag (e.g., “Advance Care Plan”)
• Copies with person/MTDM/GP/residential facility

Proper storage and flagging are crucial for easy access and recognition in medical settings.

Question 19

VAD (Vic): list the core eligibility criteria (all required).

Answer 19

• Adult (≥18)
• Ordinarily resident in Victoria (and Aus citizen/PR)
• Decision-making capacity about VAD
• Incurable advanced progressive condition causing death (≤6 months; ≤12 months neurodegenerative)
• Suffering intolerable to the person

These criteria ensure that only eligible individuals can access VAD services.

Question 20

VAD pathway: what are the three requests?

Answer 20

• First (verbal) request to a doctor (becomes Coordinating MP)
• Written declaration with two witnesses + appointment of a contact person
• Final request to Coordinating MP (triggers permit/prescription)

This pathway outlines the steps necessary for accessing voluntary assisted dying.

Question 21

VAD roles: who are the two doctors and what do they do?

Answer 21

• Coordinating Medical Practitioner (coordinates, first assessment, reporting)
• Consulting Medical Practitioner (independent second assessment)

Both doctors ensure that the options and risks are explained and that eligibility criteria are met.

Question 22

How must dispensed VAD medication be stored and managed?

Answer 22

• Dispensed in a locked box with clear labels on use/handling/storage/return
• After death, contact person must return unused medication to the dispensing pharmacist within 15 days

Proper storage and return protocols are essential for safety and compliance.

Question 23

After VAD, what is recorded as the cause of death on the death certificate?

Answer 23

The underlying disease/condition

It is important to accurately reflect the cause of death without mentioning VAD or related terms.