Ministry Seeks Public Feedback on Health Care Decisions Bill
The Ministry of Health is seeking feedback from persons on the proposed legislation to facilitate individuals’ wishes surrounding medical care and treatment, including end of life care.
This legislation seeks to provide a structure that will allow persons to make advance health care directives, or ADs. An AD is a document made by a person which expresses their specific wishes for medical care in the event they become mentally incompetent.
Pointing out that such legislation has the potential to impact everyone in the Cayman Islands, Health Minister Dwayne Seymour notes that it seeks to ensure that all persons can benefit from a modern standard of healthcare that is in keeping with their express wishes.
“We currently have no such legislation in place. As a result healthcare providers often face difficulties with families and caregivers of patients who are unable to make decisions for themselves or whose preference for treatment cannot be honoured,” the Minister explained.
The bill is the outcome of substantial work over the past year by the Ministry of Health and a committee of relevant stakeholders. This group included practitioners from the Cayman Islands Health Services Authority, CTMH Doctors Hospital, Health City Cayman Islands, Cayman Islands Hospice Care and other private health care practitioners.
Examples of scenarios that may require ADs include if a person does not wish to undergo a stated type of health care, or becomes terminally ill and wishes to be denied life-sustaining measures.
The bill specifies that advanced directives can only be made by a person over the age of 18, who is mentally competent. An AD must be signed in front of two adult witnesses, neither of whom can be that person’s beneficiaries.
The person making the directive (the directive maker) can also revoke it at any time, while mentally competent. This must be done in writing, signed and dated.
It is also possible for someone to appoint one or more proxies to act as a substitute decision maker where the directive maker becomes mentally incompetent. The underlying principle of such appointments is that these persons should act consistently with what the directive maker would have decided.
Advance directives only take effect when the directive-maker is deemed by a medical doctor to be mentally incompetent and hence unable to understand the nature and effect of any healthcare decisions that they may need to take.
While doctors can and may provide advice about care and treatment, it is useful to them to know in advance a patient’s wishes and beliefs in order to provide care in keeping with that person’s wishes at the end of life. The law also provides guidance and protections for doctors and hospitals where patients are receiving care.
The bill envisions that the Cayman Islands would recognise advance directives from other jurisdictions, such as: the United Kingdom, Canada, Jamaica, United States and the European Union.
It further stipulates that an AD may be revoked where a registered practitioner, or any other person, is aware that the directive maker had expressed a wish to revoke the directive; or where the directive is considered not to be in the patient’s best interest.
Ministry of Health Chief Officer Jennifer Ahearn notes that the impetus for the new legislation were concerns expressed on the subject at the annual Health Care Conference three years ago and requests submitted to the Ministry by medical practitioners at the H.S.A.
“Stakeholders expressed the need to develop appropriate legislation and guidelines that would allow medical professionals and family members to uphold patients’ expressed preferences about treatment and end of life decisions, whilst at the same time respecting their dignity” Ms Ahearn remarks.
The Ministry of Health welcomes comments from the public, which should be submitted by mail, email, or in person to the contact details below by close of business on 30th September, 2018.
Senior Policy Advisor, Janett Flynn
Ministry of Health, Environment, Culture and Housing
5th Floor, Government Administration Building
Elgin Avenue, PO Box 110
George Town, Grand Cayman
Cayman Islands, KY1-9000