Policy context

  • United Nations Convention on the Rights of the Child (United Nations 1989)

    Australia ratified the Convention in 1990 and therefore has a duty to ensure all children enjoy the rights set out within it. Of particular relevance to advance care planning are:

    • Article 3, which states that ‘in all actions concerning children … their best interests shall be a primary consideration’
    • Article 12, which states that ‘a child who is capable of forming his/her view has the right to express those views freely on all matters affecting the child, the views of the child being given due weight in accordance with the age and maturity of the child’
    • Article 13, which states that the child should have the ‘freedom to seek, receive and impart information and ideas of all kinds’.  

    Advance care planning: have the conversation; A strategy for Victorian health services 2014–2018 (Department of Health 2014)
    Aims to ensure all Victorians accessing health services will have opportunities to express their preferences for future treatment and care through advance care planning. The strategy acknowledges but does not specifically address the issue of advance care planning in paediatrics.

    National framework for advance care directives (Australian Health Ministers’ Advisory Council 2011)
    This framework does not make provision for children.

    Medical Treatment Act 1988

    This act does not make provision for children.

    Guardianship and Administration Act 1986

    This act does not make provision for children.

    Medical Treatment Planning and Decisions Bill 2016
    The Victorian Government introduced legislation to Parliament in September 2016, which if passed will take effect after March 2018. This will provide greater clarity regarding the legal status of advance care plans. Importantly, the Bill clarifies that a child who has decision–making capacity can make their own medical treatment decisions or execute an advance care directive which will apply as a legal document in the event they do not have capacity at a future time. It is already recognised that if a child has capacity they should be able to make some of their own medical treatment decisions. While the proposed Bill does not yet affect the current legal landscape regarding these issues, unless and until it commences, health professionals should make themselves aware of its proposed effect.

    Strengthening care for children with a life-threatening condition 2008–2015

    (Department of Health 2008)

    This policy aims to ensure Victorian children with life-limiting conditions have access to high-quality palliative care. Principle 1, Information and Decision Making, highlights the importance of including children and families in decision making.

    ‘Children with a life-threatening condition and their families have information about options for their future care and are actively and appropriately involved in those decisions.

    The expected outcomes are:

    • Children and their families are consulted about who is informed about their care and who makes decisions about their care.
    • Children are informed about and involved in making decisions about their care as appropriate to their age and developmental stage.
    • Families of children with a life-threatening condition are informed about and involved in decision making about their child’s care.
    • The unique needs of a child with a life-threatening condition and their families are addressed through developing and implementing an agreed plan.’