Introduction

At St Vincent’s Private Hospital Toowoomba, patients and their families are encouraged to partner with their health team in making decisions about their care. Your values, goals and concerns are balanced with screening, treatment and management options and the risks and benefits of each. You are supported in putting your voice forward, asking questions, involving those you love, and making decisions that best suit you.

This ‘person centred care’ framework embraces five attitudes, including:

• empowered decisions
• consistent communication
• embracing individuals
• compassionate response
• authentic relationships.

This framework complements shared decision making in health care. The following guide provides an overview of the types of decisions that may be needed while you are in hospital, and how we can work together.

Informed decision making

You have the right to decide what is right for you. 

In order to make good decisions you need to have good information. Informed decision making is based on effective communication between you and your health care team throughout your health care journey. 

Members of your family or others close to you may be involved – it is your choice. You have the right to accept or decline healthcare based on the information provided and your own personal circumstances, beliefs and priorities.

Informed consent

In healthcare, informed consent is a person’s voluntary decision about medical care that is made with knowledge and understanding of the benefits and risks involved.

You can provide your consent in a number of different ways. You could give your arm when the nurse asks to check your blood pressure; you could sign a consent form when you have an operation or agree to certain costs. In all cases, you need to understand what is happening.

As far as possible, you should have information about:

• the diagnosis/reason for a treatment or procedure
• recommended care
• risks or complications
• alternatives
• the ability not to accept
• any long term outcomes
• anticipated recovery implications.

You can ask to clarify any information and use the available time to make your decision. This might mean taking time with family or loved ones to discuss your decision. You can also change your mind or withdraw your consent. 

Decline or withdrawal of consent

You are able to decline or withdraw from treatment and you are able to change your mind. If these situations arise, the healthcare team must ensure you have the capacity or the ability to make decisions. The healthcare team also needs to check that they have provided you with the information that gives you a good understanding to make a decision. 

In these cases, you may like to:

• discuss the effects and risks of the decision in further detail
• seek a second opinion
• seek other appropriate healthcare.

Inability to give consent

All adults are presumed to have capacity or the ability to make a decision. In cases where it is difficult to understand the information, a substituted decision maker may be needed. An example of this may be if a patient is confused or very unwell. The adult’s existing supportive relationships are taken into account. In an emergency situation, the healthcare team may need to seek guidance from a substituted decision maker.

You may have already nominated an Enduring Power of Attorney. This is your substituted decision maker. Others who would be considered are:

• a spouse, if the relationship is close and continuing
• a carer who is not a paid carer
• a close friend or relation.

At admission, it is important for you to nominate your primary contact person in case of an emergency. You will also be asked to nominate a second contact person or back-up and your enduring power of attorney if you have one.

Children and consent

Children and young people under the age of 18 are able to give consent IF they have capacity. However, those under 18 are presumed to not have capacity unless there is sufficient evidence. If a young person has the capacity to give consent, this consent may be applied for routine medical treatment. It is still good practice to encourage them to seek the involvement of a parent or other adult of their choosing before making a decision.

Future health care

You can guide your future health care in different ways. You do not have to have it written down but you may have written your wishes in an Advanced Health Directive or you may have discussed your plans with someone close to you. Either way, it is important for you to talk to your family and health care professional/team. This is generally not a ‘one off’ discussion but a long term communication between you and your family, friends and health care professional.

If you become unable to make decisions, a representative can make decisions on your behalf (refer the section Inability to Give Consent). The decisions they make on your behalf are based on your instructions, the advice of your health care team and their own good judgement. You can provide guidance to your representatives about how decisions should be made on your behalf through:

• notes kept by your health care professional
• a statement prepared by yourself about general principles of what you would like
• a specific plan of care or advanced health directive.

It is best to avoid documents that are too directive. Your wishes should be a guide and allow flexibility for your representative to respect your values in new situations.

During your admission, your health care team may discuss your Acute Resuscitation Plan. This document explains what treatment you would or would not like if there was a sudden deterioration in your health. 

Understanding your wishes provides guidance to the health care team. In all circumstances, the health care team will provide optimal health care in a way that respects you.

Blood and blood products transfusion

It is important for you to understand the role of a blood transfusion in your healthcare. Please ensure that a member of the health care team provides you with information regarding blood transfusion. A brochure is available to help if required. If you have any questions, please discuss these with the team. You need to be comfortable with the care decisions.