The judicial role in life-sustaining medical treatment decisions.

Although there has been speculation regarding the pervasiveness and nature of judicial decisions regarding life-sustaining medical treatment (LSMT), no attempt has been made to empirically assess their prevalence or the issues they address. An exploratory study utilizing a mail survey of a nationwide random sample (N = 905) of state trial court judges was conducted to provide initial information regarding this decision-making process. Twenty-two percent of the responding judges had heard at least one LSMT case, and judicial review did not appear endemic to particular states. The number of judges hearing LSMT cases dropped from 1975 to 1981 but has increased since then. Three major issues predominate: patient competency, appointment of a surrogate decisionmaker, and resolution of the ultimate issue of forgoing LSMT. Relatively few cases either contested a prior directive's validity or involved imposing sanctions for instituting or forgoing LSMT. Although subject to different interpretations, the results suggest the courts are having a significant impact on certain aspects of the LSMT decision-making process. However, the infrequency with which any one judge is called upon to make an LSMT decision causes concern about the judiciary's ability to respond in a timely and appropriate manner. With their potential for a profound effect on the actions of health care providers, greater attention to this decision-making process is warranted.     

The growing role of carers in the administration of medications

The roles of registered nurses, enrolled nurses, nurse practitioners and midwives in the administration of medications are subject to the legislation and regulation in their respective States and Territories in Australia. Underpinning this regulatory framework is a presumption that health professionals who come under the relevant legislation and regulations have attained the levels of competency, skill and knowledge consistent with professional standards and the protection of the public. This column considers the provisions of the Health (Drugs and Poisons) Regulation 1996 (Qld) addressing the administration of controlled and restricted drugs in light of a recent Queensland Civil and Administrative Tribunal decision.