Supporting Adults with decision making, the review of the Protection of Personal and Property Rights (PPPR) Act.
Ben Gray1, University of Otago Wellington 1University of Otago, Wellington, Wellington, New Zealand
Abstract
The PPPR Act is to be replaced. I will describe at the significant flaws in the current processes and propose a different framework.
The current act focuses on who has the right to decide: the patient, if without capacity their substitute decision maker, or the doctor, rather than on how to reach a good decision. These decisions are presumed to be autonomous. Supported decision making is only considered for people with diminished capacity.
There are few mechanisms to address disagreement other than going to court, which is either impractical or beyond the means of many.
The United Nations Charter on the Rights of People with Disability advocates for supported decision making, arguing that finding a person lacks capacity removes their legal rights. I will describe the flaws in the capacity assessment process.
I will discuss a strategy based around shared decision making. The presumption is that all adults (not just those with diminished capacity or disability) need support for important decisions. Support might include support from the doctors to explain their treatment options, their family to include the ways in which the decision might affect others in the family and any significant others involved in their life and care. If agreement is reached, then whether the patient has “capacity” makes no difference to the decision. If agreement is not reached, we need a disputes resolution service that may be based around clinical ethics committees, or family group conferences. The court will always be needed as a last resort.
Biography
Associate Professor Ben Gray retired 2 years ago from working as a GP in a high needs practice after 27 years. He has convened the undergraduate teaching in Professional Development, Ethics and Health Law for the past 16 years and has completed an MBHL from Otago. He has a particular interest in cross cultural care and the intersection between cultural competence bioethics and health law.