Monday, September 16, 2013

SCHEDULE 1 – REFUSAL OF TREATMENT CERTIFICATE: COMPETENT PERSON – MENTAL HEALTH ACT 1988



We certify that we are satisfied—
(a)  that ........................................................... (name of patient) has clearly expressed or indicated a decision, in relation to a current condition, to refuse—
*medical treatment generally;
or
*medical treatment, being ................................................................
(specify particular kind of medical treatment);
(b)  that the patient's decision is made voluntarily and without inducement or compulsion;
(c)  that the patient has been informed about the nature of his/her current condition to an extent which is reasonably sufficient to enable him/her to make a decision about whether or not to refuse medical treatment generally or of a particular kind (as the case requires) and that he/she has appeared to understand that information; and
(d)  that the patient is of sound mind and has attained the age of 18 years.
Dated:
Signed..........................................................(Registered Medical Practitioner)
Signed ...................................................................................(Another Person)
Patient's current condition
The patient's current condition is .................................... (describe condition)
Dated:
Signed: ......................................................................................................... (To be signed by the same registered medical practitioner)
Verification to be completed by patient, if physically able to do so.
In relation to my current condition, I refuse—
*medical treatment generally
or
*medical treatment, being.................................................................
(specify particular kind of medical treatment).
I give the following instructions as to palliative care:
 
Dated:
Signed ................................................. (Patient)
NOTICE OF CANCELLATION (for completion where patient cancels the certificate under section 7 of the Medical Treatment Act 1988)
I cancel this certificate
Dated:
Signed:................................................. (Patient)
or
The patient clearly expressed or indicated a decision to cancel this certificate on                  (Date).
Signed ............................................... (Person witnessing patient's decision)
*Delete whichever is not applicable
NOTE: "Medical treatment" means the carrying out of—
(a)  an operation; or
(b)  the administration of a drug or other like substance; or
(c)  any other medical procedure—
but does not include palliative care.
"Palliative care" includes—
(a)  the provision of reasonable medical procedures for the relief of pain, suffering and discomfort; or
(b)  the reasonable provision of food and water.
The refusal of palliative care is not covered by the Medical Treatment Act 1988.

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