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Toolkits and Protocols

Opting Out of Breast Cancer Treatment
About.com. Breast Cancer

Refusal to consent to treatment on religious grounds
Murdoch University Electronic Journal of Law

Refusal of Medical Treatment
Office of the Public Advocate – Melbourne, Victoria

Refusing Treatment
Ethics & Health Law News

Maternal Decision-Making – 2013
Australian Medical Association Position Statement

Cases

Airedale National Health Service Trust v Bland [1993] AC 789 UK
UK case that is often cited in Australian Courts. Regards a young man who has been in a persistent vegitative state with no prospect of recovery. Case concerned whether withdrawal of artificial feeding and other measures keeping Bland alive would constitute a criminal offence as the consent of the individual was not attainable. Contains a discussion on the need for consent and the ability of patients to refuse treatment. See at 863-4 and 857

Hunter New England Area Health Service v A [2009] NSWSC 761
NSW
The case concerns a unconscious patient who had an advance care directive refusing certain treatments. Issues: whether directive was a valid indication of patient’s desire and whether patient had capacity to make the directive. Provides an excellent summary of the principles on consent and advance care directives.

Malette v Shulman Canada
Case of a Jehovah’s Witness patient brought to hospital unconscious and in need of a blood transfusion. Wallet contained a card stating that under no circumstances should a blood transfusion be given. Doctor provided the transfusion and was found guilty of trespass. Court held that it is no defence to trespass that the patient will die without the treatment.

Queensland v D (unreported, de Jersey CJ, 28 August 2002).
In this case the pregnant woman was a prisoner with intellectual impairments with a tendency to reactive impulsively and aggressively. An application was made to the Supreme Court to approve forcible treatment of the prisoner should she unreasonably refuse treatment. de Jersey CJ made the orders on the basis that the prisoner may suffer a temporary incapacity rendering her incapable of making rational decisions. The hearing was ex parte and the prisoner was not informed that an application has been made.

Re B (adult: refusal of treatment) [2002] 2 All ER 449 UK
A competent woman was paralysed from the neck down and could not breath without a ventilator. She requested for her ventilator to be switched off. Doctors were worried this would be construed as an act of killing. High Court held that she was competent to refuse treatment and so to continue treating her would be unlawful.

Re MB (1997) 38 BMLR 175 (Court of Appeal) UK
A competent woman can refuse a caesarean even if it means the child’s and/or her own death.

Re T (adult: refusal of treatment) [1992] 4 All ER 649 UK
Looks at the scope of refusal of treatment and the need to ascertain whether a person has the capacity to refuse treatment.

St George’s Healthcare NHS Trust v S (1998) 44 BMLR 160 (CA)    UK
Case of a pregnant woman who refused treatment even though she and her child were in danger of dying without treatment. Held that she had a right to refuse treatment.

Qumsieh v GAB and Pilgrim [1998] VSA 45 Vic
Highlights some of the issues with the refusal of medical treatment, the use of advance care directives and guardianship orders.

Papers, Reports and Books

Fetal Welfare and the Law
AMA Position Statement 1996
Australian Medical Association (member access)
Position paper from the AMA on the rights of pregnant women to refuse treatment, even if it may lead to harm or even death of the fetus. The treating physician should resort to education and information rather than forced treatment.

Refusal of Treatment
Malcolm H Parker, Bernadette Tobin (MJA 2001; 174: 531-532)
not available online

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