Principles of decision-making
When making a decision under an advance care directive, a substitute decision-maker must, as far as is reasonably practicable [Advance Care Directives Act 2013 (SA) s 35(1)(a)]:
The substitute decision-maker must make the decision that he or she reasonably believes the person who gave the advance care directive would have made in the circumstances [s 35(1)(b)] and must act in good faith and with due diligence [s 35(1)(c)].
A substitute decision-maker should not ignore professional advice or damage any relationships or friendships that the person has. The substitute decision-maker can request services and information from service providers, and has the authority to speak on behalf of the person who appointed them, to ensure that necessary services are provided.
Making decisions when there is more than one substitute decision-maker
If more than one person is appointed as a substitute decision-maker, then the substitute decision-makers may either make decisions together, or separately [s 22], unless the advance care directive says otherwise. An advance care directive may require substitute decision-makers to make decisions together. Alternatively, an advance care directive may say, for example, that one substitute decision-maker can make decisions about certain matters, and another substitute decision-maker can make decisions about other matters.
Notification of decisions
If a substitute decision-maker makes a decision under the advance care directive, he or she must take reasonable steps to notify each other substitute decision-maker appointed under the advance care directive of the decision [s 25].
A health practitioner who is providing, or is to provide, health care to a person who has given an advance care directive and who has impaired decision-making capacity in respect of a decision that is required in relation to the health care [s 36(1)]:
Health practitioners are exempt from complying with the above requirements under Section 36(1), however, in respect of health care where:
See Advance Care Directives Regulations 2014 (SA) reg 12A.
When an advance care directive may not be followed
A health practitioner may refuse to comply with a provision of an advance care directive if the health practitioner believes on reasonable grounds that [s 36(2)]:
A health practitioner may refuse to comply with a provision of an advance care directive that specifies the kind of health care that the person who gave the advance care directive wishes to receive if such health care [s 36(3)]:
However, a health practitioner must still comply with a binding provision even if it is not consistent with any relevant professional standards or does not reflect current standards of health care in the State [s 36(4)].
Similarly, if a provision of an advance care directive relates to the withdrawal or withholding of health care, including the withdrawal or withholding of life-sustaining measures, then a health practitioner cannot refuse to comply with the provision on the basis that it is not consistent with any relevant professional standards or does not reflect current standards of health care in the State [s 36(4)].
A health practitioner may refuse to comply with a provision of an advance care directive on conscientious grounds [s 37]. In this case, care of the person should be given to another health practitioner.