August 7, 2019

Dr Barbara Hayes: Public Advocate Guides

Dr Barbara Hayes recently spoke at the launch of two Office of the Public Advocate Guides on medical treatment decision making at the Carers Victoria, Dementia and Family Carers Conference. Launched by Colleen Pierce, Public Advocate from the Victorian Office of the Public Advocate, the guides cover five areas that relate to making medical treatment decisions for a person who lacks medical decision making capacity – to consent to their own treatment.

Dr Barbara Hayes (on the left) at the launch of the two Office of the Public Advocate Guides on medical treatment decision making.

The areas covered are medical decision-making framework, the role of the medical treatment decision maker, using advance care directives, using the form, ‘What I understand to be the person’s preferences and values’ and medical treatment plans.

Dr Hayes chaired a Department Health Human Services, Working Group that developed resources for people who lack capacity to do advance care planning.  The Guides were some of the resources developed and have now been adopted by the Office of the Public Advocate.

Dr Hayes explains: “There is a clinician guide:  ‘A clinician’s to guide medical decision making:  for when the person lacks capacity to undertake advance care planning’. There is also a consumer guide, aimed at those who will need to make medical decisions for another person who is no longer able to make them for themselves, titled ‘A medical treatment decision maker’s guide: for when the person lacks capacity to undertake advance care planning’.”

Dr Hayes speaking at the launch said: “I was very pleased to be part of this work that addressed an area not covered by written Advance Care Directives alone.”

Barbara explains that many people choose not to write an Advance Care Directive. “Instead, they may have done oral Advance Care Planning, communicating their preferences and values to their Medical Treatment Decision Maker who must apply that knowledge to any decision.”

“The Guide for Medical Treatment Decision Makers helps those in that role better understand their obligations and how they should make decisions, recognising how hard it can sometimes be to make decisions for another. The Guide for Clinicians brings together the legal, the clinical, and the personal aspects of substituted medical decision-making, helping the clinician to better understand their role and responsibilities, and how to facilitate this decision-making.”

The Guides reflect experiences and teaching already in place by the Advance Care Planning Program at Northern Health. The program has been a leader in Victorian Advance Care Planning, with many other health services adopting the Northern Health ‘Advance Care Planning in 3-steps’ approach. This developed from research identifying the importance of a values-based approach to Advance Care Planning, particularly when our community is so culturally and religiously diverse.

“We needed an approach that was respectful of and captured that diversity. The three steps use the ACP mnemonic: Appoint Another; Chat and Communicate; and Put it on Paper, ” says Barbara.

Dr Hayes also has an extensive experience as a Palliative Care Doctor at Northern Health, and although not working clinically, Dr Hayes continues to be involved in research and teaching. This includes: trialling the NH Care of the Dying Patient Plan; supervising Registrar research exploring issues related to diagnosing dying, understanding of dementia and knowledge of the Medical Treatment Planning and Decisions Act; a study looking at RACF patients who die within 24hrs of transfer; an NHMRC study led by A/Prof Kwang Lim at Melbourne Health that aims to improve palliative care for residents in Aged Care Facilities and uses a RACF Goals of Care developed by Dr Hayes in collaboration with NH Aged Care clinicians; and the Melbourne Ageing Research Collaborative’s end-of-life care research.

Copies of ‘A clinician’s to guide medical decision making’ are available here and ‘A medical treatment decision maker’s guide’ here and at the Northern Hospital Library.