In a world first, the Australian state of Victoria is allowing children of any age to write their own advance care directive that doctors are obliged to follow. The new ACDs, which come into effect in March next year, will allow a child to decide on their treatment preferences, provided he or she was competent at the time of making the declaration, and the statement was witnessed by a medical practitioner and one other witness.
If a child has made a valid advance directive in which they have included instructions to refuse a particular medical treatment, such as dialysis or chemotherapy, a health practitioner must not provide that treatment.
Up until now, laws around the world have given parents the final say in decisions about treatment options for minors. The new laws are controversial, and run contrary to many of the legal precedents on the decision-making capacity of minors.
Writing in The Conversation, health law expert Carolyn Johnston advocated for a collaborative approach to drafting ACDs for children:
“Parents want to protect their children and health-care practitioners want to do the best for their patients. Advance directives should be drafted as a collaboration between the child, health professionals and, ideally, parents. This will enable understanding of the possible treatment options, their benefits and harms, and the impact of refusing certain treatment, resulting in a meaningful and effective advance decision.”
There has been significant debate amongst bioethicists about the “competency” of children when deciding about treatment options.
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