Appointment of Medical Treatment Decision Maker VIC (Short Form)

Appointment of Medical Treatment Decision Maker VIC (Short Form)

If you’re appointing someone you trust to make medical treatment decisions on your behalf, this is the form you need.

This do-it-yourself document generator helps you draft an Appointment of Medical Treatment Decision Maker agreement that complies with the format approved by the Department of Health and Human Services of Victoria and is entirely tailored to your requirements and needs.
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Appointment of Medical Treatment Decision Maker VIC (Short Form)

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What is an Appointment of Medical Treatment Decision Maker (Short Form )?

An Appointment of Medical Treatment Decision Maker (Short Form) is a legal document that appoints a trusted representative to make medical decisions on your behalf if you are unable to make such decisions.

Our smart form-builder follows the format approved by the Department of Health and Human Services of Victoria.

When should I use it?

The form should be used if you would like to document the appointment of a Medical Treatment Decision Maker for you.

What topics does the the Appointment of Medical Treatment Decision Maker cover?

  • Definitions and interpretation
  • Appointment of Medical Treatment Decision Maker 
  • Personal Details
  • Limitations and Conditions
  • Witness details for the appointor and each Medical Treatment Decision Maker
  • Interpreter details and statement
  • Medical Treatment Decision Maker ’s Statement of Acceptance
  • Important notices
  • Governing law and jurisdiction

What are the main decisions I need to make in creating a Appointment of Medical Treatment Decision Maker ?

  • Do you want to specify any limitations or conditions ?

You can chose to specify what limitations would apply to the powers of your Medical Treatment Decision Maker

  • Who will be your appointees? 

If you choose to appoint two people, the decision maker will be the first person listed in the appointment who is available, willing and able to act at the time.

What other names does Appointment of Medical Treatment Decision Maker go by?

An Appointment of Medical Treatment Decision Maker  is also known as: 

  • Advance care directive
  • Advance personal plan
  • Appointment of support person
  • Enduring guardianship
  • Instrument appointing enduring guardianship
  • Health direction

Frequently Asked Questions

Use this form if you wish to formally appoint one or two Medical Treatment Decision Makers, who will have legal authority (in order of appointment based on availability at the time), to make medical treatment decisions on your behalf, should you become unable to do so.

This document can:

  • Appoint up to two Medical Treatment Decision Makers to make medical treatment decisions if the Appointor is unable to do so for themselves.
  • Authorise all the powers of a Medical Treatment Decision Maker to make medical treatment decisions or impose limitations or conditions in the appointment.

This document is for an adult to appoint a Medical Treatment Decision Maker in Victoria to make medical treatment decisions for that person.

Signing in person

Use this document if the person (the Appointor) will sign the form personally. If someone else will sign the form for the Appointor, then please use the document Appointment of Medical Treatment Decision Maker (For Someone Signing on Behalf of the Maker).

Up to two appointees

Up to two Medical Treatment Decision Makers can be appointed using this document

A Medical Treatment Decision Maker’s role is to make all necessary decisions about a person’s medical treatment when they are unable to. 

In those circumstances it is the decision maker’s responsibility to make the same decisions that the person would make if they were able to. 

This decision must be informed by the Medical Treatment Decision Maker’s understanding of the person’s preferences and values. 

If the person has not made an advance care directive, the Medical Treatment Decision Maker will need to identify these preferences and values. 

This may come from verbal communications with the person or from knowledge of their values, including observations of how they have lived their life. 

A Medical Treatment Decision Maker may find it helpful to consider these preferences and values in advance of needing to make a decision. 

By recording these details in a written document, the decision maker will then have relevant information at hand to support and assist with future medical treatment decisions.

An appointment of a Medical Treatment Decision Maker may be made at the same time as an Advance Care Directive is given or at any other time.

An appointment of a Medical Treatment Decision Makers:

  • Must be in writing, in English
  • Must include the full name, date of birth and address of the Appointor
  • Must include any prescribed details in relation to any appointed Medical Treatment Decision Makers
  • Must be signed by the Appointor or at their direction
  • May appoint more than one person as a Medical Treatment Decision Maker
  • Must be witnessed in accordance with the Medical Treatment Planning and Decisions Act 2016 (VIC)
  • Must be accepted by each appointee in accordance with the Medical Treatment Planning and Decisions Act 2016 (VIC).

Section 28 (1) Medical Treatment Planning and Decisions Act 2016 (VIC)

While Section 28 (1) (e) Medical Treatment Planning and Decisions Act 2016 (VIC) allows the appointment of more than one Medical Treatment Decision Maker, you will only ever have one Medical Treatment Decision Maker acting for the Appointor at any one time. There is nothing in the legislation to permit a stipulation for a joint or several appointments.

The appointed Medical Treatment Decision Maker (i.e., the person who will make the medical treatment decisions for the Appointor at the appropriate time) is the first person listed in the appointment who is reasonably available and willing and able to act at the particular time. 

Section 28 (2) Medical Treatment Planning and Decisions Act 2016 (VIC)

For more information please consult the Victorian Department of Health and Human Services publication titled Checklist of steps for appointing your Medical Treatment Decision Maker

Section 55 of the Medical Treatment Planning and Decisions Act 2016 (VIC), allows the Appointor to appoint a Medical Treatment Decision Maker in compliance with the formalities of that Act.

Section 55 (1) stipulates that the Medical Treatment Decision Maker is the first appointee who is reasonably willing and able to make the medical treatment decision.

 

If no formal appointment has been made then section 55 (2) stipulates that a guardian appointed by VCAT under the Guardianship and Administration Act 1986 (VIC) has the power to make a medical treatment decision.

If neither of section 55 (1) or (2) apply then section 55 (3) provides that the Medical Treatment Decision Maker is the first of the following persons who is in a close and continuing relationship with the Appointor and who in the circumstances, is reasonably available and willing and able to make the medical treatment decision:

  • The spouse or domestic partner of the Appointor
  • The primary carer of the Appointor
  • The first of the following, and if more than one person fits the description in the sub-paragraph, the oldest of those persons
  • An adult child of the Appointor
  • A parent of the Appointor

  • An adult sibling of the Appointor
An adult with decision-making capacity may appoint another adult as the person’s appointed Medical Treatment Decision Maker

All of the following are stipulated by Section 61 of the Medical Treatment Planning and Decisions Act 2016 (VIC)

To make a decision, the Medical Treatment Decision Maker must do the following:

  1. First, consider any valid and relevant Values Directive (Note: if the Adult has made an Advance Care Directive, then the values directive will be contained in Part 2 of the Values Directive.)
  2. Next, consider any other relevant preferences that the Adult has expressed and the circumstances in which those preferences were expressed
  3. If the Medical Treatment Decision Maker is unable to identify any relevant preferences under paragraph (a) or (b), give consideration to the Adult’s values whether
    1. expressed other than by way of a Values Directive; or
    2. inferred from the Adult’s life
  4. Also consider the following:
    1. The likely effects and consequences of the medical treatment, including the likely effectiveness of the medical treatment, and whether these are preferences consistent with Adult’s preferences or values; and
    1. Whether there are any alternatives including refusing medical treatment that would be more consistent with the Adult’s preferences or values
  1. Act in good faith and with due diligence.

If the Medical Treatment Decision Maker is unable to apply the process above because it is not possible to ascertain or apply the Adult’s preferences or values, the Medical Treatment Decision Maker must then:

  1. make a decision that promotes the personal and social wellbeing of the Adult, having regard to the need to respect the person’s individuality
  2. Consider the following:
    1. the likely effects and consequences of the medical treatment, including the likely effectiveness of the medical treatment, and whether these promote the Adult’s personal and social wellbeing, having regard to the need to respect the Adult’s individuality; and 
    2. whether there are any alternatives, including refusing medical treatment, that would better promote the Adult’s personal and social wellbeing, having regard to the need to respect the person’s individuality;
  3. Act in good faith and with due diligence.

If necessary, the Medical Treatment Decision Maker must also consult with any person who the Medical Treatment Decision Maker reasonably believes the Adult would want to be consulted in the circumstances.

A person may sign an appointment at the direction of the Appointor if the person signing:

  • Is an adult person;
  • Is not a witness to the signing of the appointment; and
  • Is not an appointed Support Person

A person may sign an appointment at the direction of the Appointor if the person signing:

  • Is an adult person;
  • Is not a witness to the signing of the appointment; and
  • Is not an appointed Support Person.

“Decision-making capacity” is defined as a person who is able to do the following:

  • Understand the information relevant to the decision and the effect of the decision
  • Retain that information to the extent necessary to make the decision
  • Use or weigh that information as part of the process of making the decision
  • Communicate the decision and the person’s views and needs as to the decision in some way, including by speech, gestures or other means.

An adult is presumed to have decision-making capacity unless there is evidence to the contrary.

You will need the following information:

  • Parties: Particulars of the Appointor, Support Person details, including names, addresses where applicable.
  • Witness details for the Appointor and the Medical Treatment Decision Maker including names and addresses where applicable.
  • Interpreter details for the Appointor and the Medical Treatment Decision Maker including names and addresses if applicable.

There are several signing options available. How you sign largely depends on where the parties are located and if they will attend signing together. You can print on paper and sign, or use electronic signature tools such as Docusign or Hellosign.

If you need any assistance please contact us directly, we would be happy to assist.

If you have any questions or are uncertain about any aspect of the document please do not sign it or use it. Please contact us directly and we would be happy to assist.

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