Journal of law and medicine
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This study aimed to describe the perceived barriers faced by emergency clinicians in utilising mental health legislation in Australian hospital emergency departments. A semi-structured interview methodology was used to assess what barriers emergency department doctors and nurses perceive in the operation of mental health legislation. Key findings from the interview data were drawn in accordance with the most commonly represented themes. ⋯ Many felt that clarification of legislative issues around duty of care and intoxicated or violent patients was required. The authors conclude that access block has detrimental effects on emergency mental health care as it does in other areas of emergency medicine. Consideration should be given to uniform national mental health legislation to better serve the needs of people with mental health emergencies.
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The resolution of disputes that arise out of the provision of health care services has historically taken place at an institutional level, with the hospital administrative unit conducting the process, or through the legal system with the parties traversing the relevant courts and tribunals. Increasingly, the wide range of decisions which must be made in relation to the delivery of patient and client care and the broad scope of variations in expectations as to what a health service is capable of delivering, are providing fertile ground for conflict. This column considers the potential role of mediation as an early intervention strategy to resolve health care disputes.
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The inquest into the death of Kerrie Wooltorton in Norfolk, England, ignited extensive public debate on the scope of the common law right to refuse medical treatment where a patient is distressed, depressed or actively suicidal. In Australia, a patient's wishes need not be honoured if the patient is not legally competent, if he or she falls within the ambit of the compulsory treatment provisions in the mental health legislation, and possibly also if there is a recognised public interest in preventing suicide which is sufficient to override the patient's choice. This article argues that decisions about whether to give medical treatment despite an apparent refusal should be based solely on a determination of the patient's competence to make their own choice. However, the test for legal competence must take into account the person's agency in making the decision, and decisions which will effectively end the person's life must be shown to be thought through.
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We are bedevilled with varying definitions of death, ranging from higher brain death to cardiovascular or somatic death. They all try to capture what is essential to our reasoning about the importance of human death. ⋯ The form of humanity comprises a holistic package of properties which cannot be dealt with in a reductive manner and which our criteria for death must answer to. When that is clarified, the role of these criteria and their importance both become more transparent.
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This is the second article in a series of three that examines the legal role of medical professionals in decisions to withhold or withdraw life-sustaining treatment from adults who lack capacity. This article considers the position in Queensland, including the parens patriae jurisdiction of the Supreme Court. ⋯ The article examines the level of training medical professionals receive on issues such as advance health directives and substitute decision-making, and the available empirical evidence as to the state of medical professionals' knowledge of the law at the end of life. It concludes that there are gaps in legal knowledge and that law reform is needed in Queensland.