Centre for Health Governance, Law and Ethics, Sydney Law School, University of Sydney, Sydney, NSW.
Med J Aust. 2012 Apr 2;196(6):406-8. doi: 10.5694/mja11.10824.
Futility assessments, which are unavoidable in end-of-life settings, need to be procedurally fair. This necessitates communication between health professionals and substitute decisionmakers regarding the decision to define treatments as futile. The common law test for whether treatment should be withheld or withdrawn is the best interests test. A futile treatment is not in any patient's best interests. While it is rare for the law to disagree with a futility determination made by health professionals, if a determination has been made without consultation and fails to reflect the patient's best interests, the courts will overturn it. The best regulatory regimes provide for a balance between the powers of health professionals and substitute decisionmakers to make decisions for incompetent patients, and for clear and efficient dispute resolution. The Queensland law and its requirement for consent to withhold or withdraw futile treatment represents a good model of futility determination, with clear powers given to substitute decisionmakers and health professionals. Disputes concerning the treatment of incompetent patients automatically trigger the appointment of the adult guardian as the decisionmaker, and there are avenues for appeal.
在生命末期的情况下，无效性评估是不可避免的，需要在程序上做到公平。这就需要卫生专业人员和替代决策者之间就将治疗定义为无效的决定进行沟通。是否应该停止或撤回治疗的普通法测试是最佳利益测试。无效治疗不符合任何患者的最佳利益。虽然很少有法律不同意卫生专业人员做出的无效性决定，但如果在没有咨询的情况下做出决定，并且未能反映患者的最佳利益，法院将推翻该决定。最佳监管制度规定，在卫生专业人员和替代决策者为无行为能力患者做出决策的权力之间取得平衡，并提供明确和有效的争议解决办法。昆士兰州的法律及其对同意停止或撤回无效治疗的要求代表了无效性确定的一个良好模式，明确赋予替代决策者和卫生专业人员权力。涉及无行为能力患者治疗的争议会自动触发成年监护人作为决策者的任命，并为上诉提供途径。
