Law provides framework for ‘end-of-life’ health decisions

Ezzard Miller expressed some concerns over the Health Care Decisions Bill.

There will soon be a legal framework for do-not-resuscitate orders and other advance directives related to end-of-life care.

Lawmakers passed the Health Care Decisions Bill 2019 on Wednesday, paving the way for such a framework to be established. The bill also expressly outlaws euthanasia and assisted suicide.

An advance directive lets a person determine what course they would like physicians to take in a situation where the person has become mentally incapacitated or otherwise unable to communicate their wishes. It can cover such things as an order not to put the person on long-term life support or not to resuscitate them in specific situations.

It is also possible for someone to appoint one or more proxies to act as a substitute decision-maker in cases where the directive maker becomes mentally incompetent. The underlying principle of such appointments is that these individuals should act consistently with what the directive maker would have decided.

Until now, there has been no legal provision for such arrangements. Living wills and advance directives are used here, but this bill is intended to give them a legal statement.

When he introduced the bill on Wednesday, Health Minister Dwayne Seymour said the Health Services Authority has had difficulties with families of patients who were too unwell to express their desires for treatment – difficulties such as what family member is authorised to make a decision for a patient.

Opposition Leader Ezzard Miller spoke for about 25 minutes before the bill was passed, raising concerns about potential lacunae in the legislation.

For example, Miller said the bill does not include any provisions for DNRs for children.

He also expressed worries about the Health Services Authority being held liable for medical bills incurred if an advance directive is not immediately followed. If medical bills are racked up while a living will is being considered, he asked if the HSA would be responsible for those bills.

When Seymour spoke again, he clarified that this bill only applies to adults. Parents are still responsible for the healthcare decisions of their minor children, he said.

The bill was passed unanimously.

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