Personal Preferences
When managing medications in palliative care, it’s important to involve the person and respect their wishes.
Some common risks include:
- The person is not included in decisions about their medications, or their wishes are not respected.
- The person does not get information about medications in a way they can understand.
- If the person cannot make decisions, their substitute decision-maker is not included.
- Give the person (or their substitute decision-maker) clear and relevant information to help them decide about medications.
- Make sure the person’s Advance Care Directive and other care plans are:
- up-to-date and reflect their needs and wishes
- accessible to care staff to guide decisions about medications.
- Regularly check with the person (or others helping with decisions) to make sure they have the information they need and feel their wishes are being heard.
- Conduct routine audits to confirm medication and treatment preferences are recorded and accessible in the aged care facility.
Person-centred care
The person nearing the end of life should always be at the centre of decisions about their care and treatment. They must be part of every choice about their medication and other treatments. If the person can make decisions, they have the right to choose whether to accept or refuse medication and treatment.
People have different views and preferences about using medications. These preferences can be shaped by their culture, faith, or personal beliefs and values. It's important to listen to and respect these choices in providing care.
People have the right to refuse treatment or medication
Dignity of risk means that a person has the right to make their own decisions about their care, even if those choices involve some risks. This includes the right to refuse medical treatment, including medications, that are needed to keep them alive.
If a person chooses to refuse treatment or medication, their decision should be respected. This means the treatment or medication should not be given, even if it means the person may die without it.
It is important to make sure these decisions are clearly recorded in the person's care documentation, and that medical staff are informed when someone refuses treatment or medication.
Giving medication or treatment to a person against their wishes is considered assault. It can also lead to treatment that is not helpful or wanted, and may cause distress for the person, their family and friends, and the health professionals involved.
Preferences may be captured in Advance Care Plans
The Strengthened Aged Care Quality Standards require aged care providers to regularly assess and plan with residents to understand their current needs, goals, and preferences. This includes planning for future care, such as advance care planning and end-of-life planning, if the person wishes.
Aligning with the Standards
It is important to know if the person has expressed preferences about medication or treatment, for example, in an Advance Care Directive or other planning documents. These preferences should be clearly recorded and followed to ensure the person's wishes are respected. This is identified in the Aged Care Quality and Safety Commission’s Strengthened Quality Standards:
- Outcome 3.1: Assesment and Planning
- Outcome 5.7: Palliative and end-of-life care.
and the National Palliative Care Standards for All Health Professionals and Aged Care Services:
- Standard 1: Comprehensive Assessment of Need
- Standard 2: Developing the Comprehensive Care Plan
- Standard 4: Providing Care.
Others may support decision-making
Some people may choose to involve their family, friends, or health professionals to help them make decisions about their care and treatment.If the person is unable to make decisions for themselves (as determined by their doctor), a substitute decision-maker can make decisions about their medical treatment on their behalf.