Patients' decisions to die: the emerging Australian jurisprudence

A series of decisions by McDougall J in Hunter and New England Area Health Service v. A (2009) 74 NSWLR 88; Martin CJ in Brightwater Care Group (Inc) v. Rossiter (2009) 40 WAR 84; Higgins CJ in Australian Capital Territory v. JT (2009) 232 FLR 322; and Kourakis J in H Ltd v. J (2010) 240 FLR 402 has built upon prior decisions in New South Wales, Queensland and Victoria. The combination of authority has provided a reasonably homogeneous set of principles on the basis of which future decision-making can take place by clinicians, institutions and courts. It is apparent that, wherever possible, effect will be given to competent patients' wishes in relation to cessation of treatment, nutrition and hydration. However, scrutiny will be applied to patients' capacity in order to examine not the rationality or correctness of their decisions per se but their capacity to make them. It is probable that a rigorous approach will be taken both to whether patients' mental ill health deprives them of capacity and to whether they are provided with sufficient information to understand the consequences and processes of deprivation of nutrition, hydration and medication.