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HUMAN RIGHTS, OLDER PEOPLE AND DECISION MAKING
IN AUSTRALIA
LISE BARRY & SUSANNAH SAGE – JACOBSON*
In Australia, someone who is concerned about the decision making capacity of an older person can seek orders from a Tribunal to grant them Powers of Attorney. This substitute decision making power denies the autonomy of the older person and may serve to allow family, caregivers or professionals to override the wishes of an older person. In extreme cases, this can lead to situations of financial, psychological and even physical abuse.
A human rights approach to the assessment of legal capacity may offer improved legal protections for older people and is advocated in as advocated in ARNLA’s draft Charter of Rights and Freedoms for Older Persons.[1] Further a human rights approach to capacity aligns with philosophical understandings of autonomy and vulnerabilityrecognised by the law. This approach moves away from status based or outcomes based capacity assessments and replaces substitute decision making powers with supported decision making processes wherever possible.
Article 1 of the ARNLA Charter provides:
Older persons have the right to be treated with dignity and humanity and to be free to exercise personal self-determination. This includes the right to be presumed as having full decision-making capacity unless otherwise determined in accordance with law, the right to make decisions regarding their present and future circumstances and to be supported to make decisions if they have difficulty in doing so.
Article 7 of the ARNLA Charter states:
Older persons have the right to recognition as a person before the law and to be treated equally before the law.[2]
In this Article the authors demonstrate how ad hoc capacity assessments in Australia have resulted from a legal system that has not kept pace with the complexity of an ageing population.
I CAPACITY IN LAW AND THE OLDER PERSON
The concept of legal capacity is comprised of legal standing (legal recognition as a holder of rights and duties) and legal agency (which allows for the exercise of these rights and duties). A person who is declared to lack capacity is prevented from making a variety of important life decisions with significant legal ramifications. For instance, a person in Australia who is lacking capacity cannot: enter into a binding contract,[3] dispose of their property by way of a will or as a gift, [4] marry,[5] vote,[6] engage in consensual sexual intercourse,[7] consent to medical treatment,[8] become a member of parliament,[9] or carry out certain occupations. Legal capacity is essential for the exercise of economic and social rights yet it has historically has been readily denied to populations including older persons, who may experience decision making fluctuation, impairment or disabilities.
In practice, older people are frequently subjected to capacity assessments by medical and legal professionals. This may be due to ageist assumptions that they lack capacity based on their age, or because they have been diagnosed with a prevalent medical condition that may affect decision-making ability such as dementia. Or it may be a strategic decision designed to address a future challenge to the validity of a decision. Dementia related conditions are currently the leading cause of disability in Australians aged 65 and over.[10] However impaired decision making ability in the elderly may also be the result of many other conditions and diseases such as temporary illness, fever or delirium, brain damage due to stroke and intellectual disability.[11] It is also widely accepted that decision making capacity due to medical conditions will fluctuate markedly over time, that is a person may have capacity for a certain decision on one day, but lack capacity the next day due for instance to fatigue or illness.[12] Unfortunately the law as it stands has not necessarily kept pace with this practical understanding.
The required standard of legal capacity is prescribed by the High Court in Gibbons v Wright:[13]
The law does not prescribe any fixed standard of sanity as requisite for the validity of all transactions. It requires, in relation to each particular matter or piece of business transacted, that each party shall have such soundness of mind as to be capable of understanding the general nature of what he is doing by his participation.
A functional approach to capacity acknowledges that capacity is decision specific and the more complicated and multi-faceted the decision to be made, the higher the legal standard of the required capacity to be competent to make that decision.[14]The legal tests for determining the capacity standard for the range of legal decisions required to be made by older people over time has developed in the law in Australia without any coordination or consistency. As a result, the standard as to the extent to which a person with diminished capacity is then able to participate on the same terms as a person presumed to have full decision making capacity is also adhoc. The result is that current capacity assessments have the potential to open the door to elder abuse and the law as it stands in Australia does not do enough to promote the autonomy of older persons with diminished decision making abilities to protect them from abuse. An examination of the laws of guardianship and powers of attorney demonstrate some of the practical effects of a bright line approach to legal capacity in the elder law context and highlights how a human rights approach in these jurisdictions will go some way toward remedying the deficiencies in the system.
II THE BRIGHT LINE APPROACH TO THE LOSS OF CAPACITY
Australian law does not explicitly recognise or accommodate an older person’s need to gain staged or varying types of decision-making support to address fluctuating capacity while still maintaining the ability to make their own legally valid decisions about their life. Under Australian law a person may only fall on one of two sides of a capacity ‘bright line’; that is they either have full decision making capacity at law, or they do not have any capacity to make any lawful decisions at all. If a person is deemed to have legal capacity, they may continue to make their own decisions however if they are deemed not to have capacity, the consequence is that someone else, a substituted decision-maker must then make all decisions on their behalf thereafter for their lifetime. It is an all or nothing approach that favours the legal certainty and validity of the decision being made, over the lawful rights of the person seeking to make it.
In addition to theoretical concerns, there are two practical difficulties with the concept that there is a bright line to separate those with and those without capacity. Firstly and most obviously, it does not reflect the reality of most people experiencing a loss of cognitive function that may reduce their legal capacity due to age, illness or disability. With the exception of the seriously injured or acutely ill, most people do not experience loss of legal capacity and the way this impacts on their ability to make their own decisions as a point in time event or a particular moment where a line is crossed. Laws relying on such a fiction that does not reflect the lived experience of diminishing capacity renders it unhelpful to the people it is designed to assist.
The second practical difficulty with the bright line model is that it transfers or affords far too much importance, weight and power to the actual capacity assessment itself. Capacity assessments are the various tests conducted by professionals to ascertain whether a person has lost their legal capacity or not. These tests are known however to be unreliable indicators of the entirety of a persons’ real decision making capacity.[15] Under this model the capacity assessment necessarily becomes the blunt arbiter of which side of the bright line a person with diminished capacity is to fall, with significant consequences for that person’s rights and wishes if they fall on the “wrong” side. Practical concerns about the bright line view of legal capacity have led to widespread recognition that the law is outdated and in urgent need of reform.[16]
III GUARDIANSHIP AND POWERS OF ATTORNEY IN AUSTRALIA
Legislation in all states of Australia that either relate to or require the use of capacity assessments all avoid setting out a uniform standard or test for capacity. In relation to older people, the key legislative frameworks that impact on decision making are the safeguards provided by state-based statutes in the areas of Guardianship and Administration and more recently Advanced Care Directives. Unfortunately, the legal tests for capacity required to invoke these laws in each of the jurisdictions remain inconsistent and unclear. They all introduce the oversight of a statutory decision-maker, such as a Tribunal member, to make decisions regarding capacity, particularly where the cognitive ability of the person is in dispute. Overall however, while the tests may vary, they all use the bright line approach to capacity. None of the statutory standards are currently able to recognise any variations in a persons’ capacity itself, that is, it is still an ‘all or nothing’ proposition.
As a result, Guardianship laws in particular have come under particular strain in recent years due to their increasing use in response to family, accommodation and health disputes relating to legal decision-making and diminishing capacity in the aging population. While the common law in Australia presumes that adults have the capacity to make decisions unless there is evidence to the contrary,[17] this presumption is not explicitly set out in Guardianship legislation other than in Queensland and Western Australia[18] and not necessarily adhered to in practice where there is a dispute over the resulting decisions being made.
In addition, due to the historical development of guardianship laws and the disability sector, in all Australian states and territories except Queensland, current legislation states that a person’s lack of capacity must be due to a disability.[19]For example, Guardianship laws in Victoria, Tasmania, Western Australia and the Northern Territory are able to be invoked when a person is ‘unable to make reasonable judgments about their affairs because of a disability.[20] In the ageing context, this suggests there must be a defined or catalyst medical event to invoke the provisions, rather than a supported or staged decline in cognitive ability. A simple diagnosis of the preliminary stages of a long-term disability such as dementia under such a test may therefore be enough to question someone’s legal capacity even where there is no real need.
Queensland’s guardianship legislation contains the most detailed capacity standard of the Australian statutes. In the Queensland Act, a person is deemed to have capacity where the person is capable of understanding the nature and effect of decisions about a particular matter, of freely and voluntarily making decisions about the matter and of communicating their decisions in some way.[21] A further additional provision then expressly recognises that the capacity of an adult may also differ according to the nature and extent of the impairment, the type of decision to be made, including, for example, its complexity and the support available from members of the person’s existing support network.[22] While comprehensive in recognising that loss of capacity may be transient, this provision is still then used for determining which side of the bright line a person is deemed to fall.
Another detailed statutory provision in relation to capacity standards is found in the Australian Capital Territory (‘ACT’) Guardianship Act. In this Act it is specified that a person cannot be found to have impaired decision-making capacity only because the person is eccentric, or expresses a particular political or religious opinion, sexual orientation or preference, or has engaged in illegal or immoral conduct or taken drugs, including alcohol (but any effects of a drug may be taken into account).[23]While this may prove a useful provision for an older person seeking to ensure they preserve their ability to make their own accommodation or lifestyle choices where a change in these choices may call their capacity into question, the provision does not alter the bright line test.
In all State jurisdictions except South Australia, where an older person wishes to try to exercise some control or make a plan for their future themselves by appointing their substitute decision maker in advance, to only take effect once they lack capacity, they must rely on the appointment of an enduring guardian or an enduring attorney. Firstly however in order to validly appoint a person with substitute decision making powers, the older person must be able to demonstrate to the person drafting or witnessing the document that they have the capacity to understand and make a valid appointment. Further once these documents take effect and a substitute decision-maker is appointed, the bright line is then unequivocally crossed and the person has no legal authority over any decisions made on their behalf going forward.
IV CAPACITY DECISION- MAKERS IN GUARDIANSHIP LEGISLATION
In practice, under all the Australian Guardianship Acts, capacity assessments in relation to appointing an enduring guardian are most often undertaken by individual lawyers, acting on the advice of a person responsible and sometimes informed by medical opinion. In other circumstances, where the appointment of a guardian or administrator is required or where a person seeks to activate an enduring guardianship, enduring attorney or advanced care directive where the capacity of the person is in dispute, the decision-maker will be an administrative tribunal member. In all Australian jurisdictions, capacity assessments undertaken by statutory decision-makers are not judicial decisions, which would allow for some discretionary interpretation of the law, but are considered to be findings of fact, or the application of the statute to the circumstances. In Australian administrative law, Tribunal members are authorised by legislation to make findings of fact under many statutory provisions. In most other administrative decisions under an enactment however, the evidentiary standards and procedural guidelines for the tests to be applied in fact-finding are also set out in the relevant statute to guide the decision-maker. In the case of guardianship, no current legislation provides for such procedure or prescribes an approach to determining whether a person is incapable of ‘managing their affairs’ or ‘exercising reasonable judgments’.
Most administrative tribunal members making decisions under guardianship law will require some medical evidence or opinion of a person’s cognitive functioning, usually via a standard form as supplied by the Tribunal that may be completed by a general practitioner, specialist doctor or a neuropsychologist. The law does require that the Tribunal member must make its own finding of fact however and it is not possible for the Tribunal decision-maker to simply defer or delegate the task of assessing capacity to a health professional by relying upon medical opinion alone.[24]As a result, many Tribunal members generally also seek out other opinions from lay persons who can attest to how the person is functioning in daily life, such as family, friends and supportive community members. Given the risk of this other lay opinion to be subjective or self-interested, the medical evidence is generally considered more highly probative and given a greater weight.
While Tribunal procedures in this jurisdiction may be readily scrutinised, a further practical problem with the fluidity of these processes under common law is that unless the question is brought before a court the standard and test used to determine capacity is not prescribed. As a legal construct, in most cases it will not be a tribunal member but an individual lawyer in a private office who decides both the standard and the test being applied, perhaps acting with information supplied by a doctor. This is highly problematic because research suggests that it is difficult even for doctors who are skilled in capacity assessment from a clinical perspective to make a definitive finding as to a person’s decision making capacity.[25]
V HEALTHCARE PROFESSIONALS AND BRIGHT LINE CAPACITY ASSESSMENTS
VI LAWYERS AND CAPACITY TESTS
In all jurisdictions in Australia, lawyers are necessarily involved in capacity assessments because they are required by professional ethics and conduct rules to follow their client’s lawful, competent instructions.[37] The practical implication of this rule is that all lawyers must ensure that their elderly clients have the capacity to instruct them. This is a role and function that most lawyers, arguably even more so than medical professionals, are not well-trained and find themselves underprepared for. In all Australian states and territories, a lawyer may be successfully sued in negligence if they accept instructions from a client who lacked the capacity to give them, however little ethical or practical guidance is available on how to go about carrying out such an assessment.[38] The professional bodies representing lawyers in some states have only recently prepared helpful toolkits for lawyers involved in capacity assessments[39]however these remain recommended by the Australian Solicitors Rules rather than mandated. [40]
In the absence of the development of a human rights approach to legal capacity by lawyers, ‘bright line’ capacity assessments may simply serve to ‘screen out’ more and more elderly people from exercising their right to make their own legal and lifestyle decisions in the future. This is particularly so in Australia, where “old age” is cited in the commentary to the legal professional rules as grounds to displace the presumption of capacity. The Australian rules and commentary on client capacity are based on competing understandings of capacity and the functional approach. In particular, the commentary to rule eight reads:
It is a presumption at common law that every adult person is competent to make their own decisions. Characteristics which may displace the presumption include old age, incapacity, mental infirmity, suspicion of undue influence or of fraud, or where the client is unable to communicate. Accordingly, while a presumption of legal capacity lies at the heart of the solicitor-client relationship, solicitors must be reasonably satisfied that their client has the mental capacity to give instructions, and if not so satisfied, must not act for or represent the client. A failure to be alert to issues of incapacity has the potential to generate liability in negligence.
Complex issues can arise when a solicitor has reason to doubt a client’s capacity to give competent instructions. A number of Law Societies have issued guidance on the ethical responsibilities of practitioners when faced with such questions. Where a solicitor is unsure about the appropriate response in a situation where the client’s capacity is in doubt, the solicitor can, pursuant to Rule 9.2.3, seek confidential advice on his or her legal or ethical obligations.[41]
The commentary becomes contradictory by including of the ‘status based’ approach to capacity based onageist assumptions about a person’s decision making ability. This is not consistent with the promotion ofthe state-based capacity toolkits, which all explicitly promote the functional approach to capacity assessment. For example, the NSW Toolkit provides at Principle 3;
Don’t assume a person lacks capacity based on appearances. It is wrong to assume a person lacks capacity because of their age, appearance, disability, behaviour, language skills or any other condition or characteristic[42]
And the South Australian guidelines state:
Doubt as to incapacity is not to be expected or assumed. This is a caveat of the first importance.[43]
Unfortunately the toolkits and guidelines rely on some knowledge and consistency in implementation and the law as it currently stands in Australia does not promote the adoption of a human rights approach to the decision making rights of older persons.
VII THE HUMAN RIGHTS FRAMEWORK IN AUSTRALIA
Equality before the law is fundamental to the exercise of our core human rights and is guaranteed to all persons by the Universal Declaration of Human Rights and the International Covenant on Civil and Political Rights. Everyone is presumed to have legal personality as of right,[44]and legal capacity is fundamental to exercising that right.[45]
The primary international human rights instrument relating to the right of people to exercise their decision making capacity is the Convention on the Rights of Persons with Disabilities (CRPD).[46] Australia is a signatory to the CRPD however due to our law on decision-making and capacity an interpretive declaration applies in relation to Article 12:
Australia declares its understanding that the CRPD allows for fully supported or substituted decision making arrangements, which provide for decisions to be made on behalf of a person, only where such arrangements are necessary, as a last resort and subject to safeguards.[47]
When Australia appeared before the 10th session of the CRPD in 2013, the Committee specifically recommended that the Interpretive Declarations of Australia be reviewed and withdrawn.[48] The Committee also made favourable comments concerning measures being undertaken in Australia to explore possible supported-decision-making law for people with legal incapacity.[49]
In order to draw together Australia’s existing international obligations under the core human rights conventions and existing state-based legislation, the Australian Research Network on Law and Ageing (ARNLA) has developed a draft Charter on the Rights and Freedoms of Older Persons.[50]Article 1 of the ARNLA Charter is designed to promote the autonomy of older people while also recognising the need to provide protections for the most vulnerable. It reads:
Older persons have the right to be treated with dignity and humanity and to be free to exercise personal self-determination.[51]This includes the right to be presumed as having full decision-making capacity unless otherwise determined in accordance with law, the right to make decisions regarding their present and future circumstances and to be supported to make decisions if they have difficulty in doing so.[52]
This Article promotes the development of supported decision making models rather than complete substitute decision-making and the appropriate use of advanced health care directives to promote self-determination for older people. Supported-decision making models require an approach that moves away from status based or outcomes based capacity assessments and recognise that the appropriate question to be asked in determining a person’s capacity to make a decision should not be based on their impairment or their capability to exercise their preferences but rather focuses on maintaining the person’s autonomy as far as possible. The question becomes;“What types of supports are required for this person to exercise his or her legal capacity?” A human rights based approach to capacity and supported decision making is also consistent with the practical understanding in the medical and disability research concerning fluctuating and diminishing capacity and also offers protections against abuse of substitute decision making powers.[53]
VIII AUTONOMY AND VULNERABILITY
From a philosophical perspective, a human rights based approach to capacity assessment in older people requires balance between principles of autonomy and vulnerability.[54] The exercise of a person’s autonomy is understood as involving three conditions: freedom, competence and authenticity[55]To assess the impact of these conditions on a person requires a holistic view of a person and may include attention to their values, preferences, lifestyle, family and socio-economic status. The concept of ‘authenticity’ in particular is a requirement that a decision illustrates a diachronic coherence (coherent over time), not just synchronic coherence (coherent in the moment).[56]An enquiry relating to the older client’s personhood must extend beyond a superficial legal interview or administration of a psychological test to require adeeper understanding of who they are. This approach to autonomy acknowledges that an older person with decision making impairment is not a “new” person, or a “shell” of the person that they once were, but that they are in fact the exact same person.
In defining autonomy in the context of the lawyer and client relationship, Pepper usefully explained that autonomy does not;
... imply isolation and disconnection for the client... To value autonomy in the political and legal context is not to assume or suggest that the self is either totally or naturally free... Rather, it is to appreciate that we ought to be very limited and careful in deciding by whom, when, and how the self is to be legally constrained.[57]
In practice, a lawyer who understands and supports the autonomy of older people must establish that the elder client’s decision is being made freely. This is not a simple assessment. As far as possible, they must establish that the decision has been made free of the undue influence of any other person affected by, or benefitting from that decision. The lawyer should also ensure that the older client has a proper understanding of what the particular decision will mean for their life in the future, in recognition of the pre-condition of competency. The older person’s decision must also be shown to be consistent with the expressed values of the older person, or in other words, that it is authentic to their personhood. This would involve a conversation with the elder about past decisions, not just the decision of the moment. In all, this assessment entails the lawyer applying nuanced client interview skills.
For most people, such an analysis of autonomy is also likely to involve the identification of certain vulnerabilities, either physical, mental, emotional or financial and which may or may not include decision making disabilities. Again from a philosophical perspective, the term ‘vulnerability’ is understood as a component part of autonomy. Margaret Hall explains;
...vulnerability is not so much the absence of (relational autonomy) but its constant shadow which may be expected to wax and wane over an individual’s life course.[58]
As something we all experience over our life course, to say that an older person is vulnerable is not to say that they require a substitute decision maker. Understanding vulnerability recognises simply that the particular strains on a person’s autonomy needs to be appreciated and addressed in order to support the exercise of that person’s legal capacity. Measures or support to address vulnerability will not require the same actions in all circumstances, but will be tailored to the individual and applied only to the sphere of their life requiring support.[59]
IX SUPPORTED DECISION MAKING AND HUMAN RIGHTS
Consistent with the concept of autonomy is the human rights principle of self-determination and a move away from bright line capacity assessments toward supported decision-making alternatives. The ARNLA Draft Charter, Article 1 provides:
Older persons have the right to be treated with dignity and humanity and to be free to exercise personal self-determination.[60]This includes the right to be presumed as having full decision-making capacity unless otherwise determined in accordance with law, the right to make decisions regarding their present and future circumstances, and to be supported to make decisions if they have difficulty in doing so.[61]
Supported decision making is described as a continuum. It may also be called a “stepped model” of decision making and is offered as an alternative to substituted decision-making.[62] At one end of the continuum is autonomous decision making, whereby a person makes their own decision without any assistance or accommodations. At the other end of the spectrum is full guardianship and substitute decision making. This acknowledges the fact that there will always be some people, including older people, whose disabilities are such that they are unable to communicate their preferences to their carers or supporters. Further, if in the case of older people, a person does not have a relationship with any family or friends who may be willing or able to act as a supporter, then substitute decision making may become an unavoidable last resort.
The distinct models of “support with decision making and supported decision making”[63]also need to be distinguished. Supports with decision making are usually for people with physical or social related vulnerability and include providing the accommodations necessary for older people to make their own decisions with little or no third party support.[64]The stress involved in some decision making processes due to inter family conflict are often identified as causing vulnerabilities that affect older people’s decision making and it should be acknowledged that finding accommodations to solve this issue is difficult. [65]
Supported decision making on the other hand, involves amendments to the law that recognize the legal standing of people who need support for their decision making.[66]Supported decision making has been defined as
a series of relationships, practices, arrangements, and agreements, of more or less formality and intensity, designed to assist an individual with a disability to make and communicate to others decisions about the individual’s life.[67]
Under this model, where a person’s will and preference is ascertained with the support of another person, that decision becomes legally enforceable as the decision of the supported person. Significantly, the starting point is not an assessment of capacity, but an assessment of the support required to express a preference.[68]Supported decision making therefore represents a radical departure from the law of substitute decision making and also raises inevitable procedural concerns. [69]If sufficient safeguards concerning education and supervision of supporters are absent from legislation, supported decision making may simply become a form of surrogate guardianship.[70] In British Colombia however, the model of Representation Agreements imposes a positive obligation upon a nominated supporter to consult with the older person who is the subject of any decision making they are involved in.[71] In some instances, additional oversight of supporters is provided for with the appointment of a monitor.[72]Concerns over how supported decision making may be implemented and achieved in practice in Australia should not necessarily trump consideration of a measure that could assist to prevent older people being subjected to unnecessary control by substitute decision-makers against their will.[73]Further if developments in the Disability sector are indicative of the path for elder law reform,[74] then the increasing influence of human rights on legal policy development is likely to lead ultimately to supported, rather than substitute decision making regimes. Supported decision making has the potential to overcome the determinism of capacity assessments and to prioritise the rights of all older people to plot their own future decision making path.
X REFORM TO LEGISALTIVE CAPACITY ASSESSMENT PRINCIPLES
A number of law reform bodies throughout Australia have recently considered the legal capacity assessment principles, specifically in guardianship and powers of attorney legislation.[75] In the absence of a uniform test and prescribed procedures for assessing capacity, it has been recognised that tribunal decision-makers may make inappropriate assumptions or inadequately weigh the evidence before them when determining capacity. Fact-finding errors relating to misinterpretations concerning fluctuating or diminishing capacity or the cognitive effects of ageing are particularly problematic for older people experiencing memory loss. The Victorian Law Reform Commission (VLRC) made the following recommendation that legislation must explicitly address certain key false assumptions about the nature of capacity made by Tribunal decision-makers;
Capacity Assessment Principles
27. New Guardianship legislation should contain the following capacity assessment principles:
(a) A person’s capacity is specific to the decision to be made.
(b) Impaired decision-making capacity may be temporary or permanent and can fluctuate over time.
(c) An adult’s incapacity to make a decision should not be assumed based on their age, appearance, condition, or an aspect of their behaviour.
(d) A person should not be considered to lack the capacity to make a decision merely because they make a decision that others consider to be unwise.
(e) A person should not be considered to lack the capacity to make a decision if it is possible for them to make that decision with appropriate support.
(f) When assessing a person’s capacity every attempt should be made to ensure that the assessment occurs at a time and in an environment in which their capacity can most accurately be assessed.[76]
The VLRC was in fact so concerned about the potential deficiencies in Tribunal decision-making processes in relation to capacity assessments and guardianship, they also recommended the Victorian government consider a new qualified capacity assessors scheme. Such a scheme would allow only trained and certified professionals to make capacity determinations as part of a new legislative approach to guardianship.[77]
The notion of specialist capacity assessors has not yet taken hold in any of the Australian jurisdictions to date, however the South Australian Advance Care Directives Act which commenced in July 2014 does contain a unique provision that appears to provide for a process for statutory capacity assessment. The Public Advocate, a statutory body, is empowered by the legislation to make declarations under the Act as to whether the person who gave the advance care directive (ACD) has impaired decision -making in relation to a particular decision.[78] This power may be invoked either by application from an interested person or by its own initiative. This role for the Public Advocate could be interpreted, in effect, as that of a specialist capacity assessor, at least in respect of Advance Care Directives legislation in South Australia. Whether or not the Public Advocate is proactive in using the power to make Declarations however remains to be seen as it is also open to the Public Advocate to defer to mediation or to the tribunal.[79]
The Advance Care Directives Act 2013 (SA) is notably the first Australian State response to the National Framework for Advance Care Directives and incorporates advance care directive provisions previously contained in two different South Australian Acts. The Act provides a mechanism where a person may validly appoint their own future substitute decision-maker to commence their role when the person’s capacity becomes impaired in the area of healthcare, residential and accommodation arrangements, and personal affairs.[80]
The important feature of this legislation is that it provides a statutory definition for impaired decision-making and standards as to capacity assessment to inform the appropriate time for the substitute decision-maker to commence their duties and safeguard the rights of the person with diminished capacity. Significantly, the Act further recognizes a decision-specific approach to capacity assessment in order to inform the need for substitute decision-making. In Section 34(1) the Act states:-
A substitute decision-maker may only make a decision under an advance care directive if, at the relevant time, the person who gave the advance care directive has impaired decision-making capacity in respect of the decision.[81]
It is too early report on the overall effects of the implementation of this Act, that is how it will affect practice and how broad the uptake of ACDs are in the community generally, however we do know that this legislation has unequivocally introduced the notion of decision-specific capacity into Australian law. This is a significant shift away from the ‘bright line’ principle of capacity assessment principles and suggests that any future legislative measures will also follow suit.
The following rights and freedoms are drawn from the principal international instruments concerning older persons – the UDHR, ICCPR, ICESCR and the UN Principles for Older Persons. In this respect, the following rights are mere replications of existing rights contained in binding treaties or in declaratory instruments which further articulate the rights of older persons (such as the UN Principles). However, the following rights also include specific mention of rights not currently recognised in international treaties – the right to palliative care, a dignified death, lifelong learning, the freedom to choose the time of one’s retirement from work, the right to plan for retirement, loss of decision-making capacity and death, the right to choose one’s preferred place of residence, the right to access an appropriate level of humane and secure residential care. In these respects, the following rights partly represent a progressive development on the existing international human rights instruments which bind nation-states. However, these rights are already reflected in many non-binding international and regional instruments, can be linked to many existing rights already protected (such as the right to palliative care being one aspect of the right to adequate health care), and have been recognised by the United Nations Office of the High Commission for Human Rights as needing specific recognition and protection under international law.
In order to combat ageism and to adequately prepare for the needs of an ageing population, a rights based approach to aged care and ageing policy is necessary. Until such time as a new convention on the rights of older persons is adopted at the international level, we must work with the existing international human rights instruments, adopting a progressive approach to their interpretation in seeking to protect the rights and freedoms of older persons. The following Charter has been drafted with this objective in mind. Where there exist no legal or constitutional impediments to its implementation in domestic law or policy, governments, government agencies, advocacy groups, service providers and community organisations should promote its adoption and implementation.
1. Older persons have the right to be treated with dignity and humanity and to be free to exercise personal self-determination.[82] This includes the right to plan for retirement, the loss of decision-making capacity and death.
2. Older persons have the right to freedom of movement and to choose their preferred place of residence. These rights shall only be restricted in accordance with law, where such restriction is necessary to protect public health, public order or morals, and the rights and freedoms of others.[83]
3. Older persons have the right to be free from torture or other forms of cruel, inhuman or degrading treatment.[84]
4. Older persons have the right to liberty and security of the person and to be free from exploitation and physical, social, psychological and sexual abuse. No person shall be deprived of their liberty, including by forced or involuntary institutionalisation, except in accordance with procedures established by law.[85]
5. Older persons have the right to own property, the right to exercise self-determination with respect to that property, and the right not be arbitrarily or unlawfully deprived of their property.[86]
6. Older persons have the right to exercise their rights free from all forms of discrimination, whether on the basis of age, sex, colour, sexual orientation, religion, political opinion, educational qualification, national origin or ethnicity.[87]
7. Older have the right to recognition as a person before the law and to be treated equally before the law.[88] Older persons are entitled to access and seek remedies for breaches of their rights, including in institutional settings.[89]
8. Older persons have the right to life, to adequate food, clothing and shelter and to enjoy the highest attainable standards of physical and mental health.[90] This includes the right to palliative care in order to preserve the best possible quality of life until death,[91] and the right to a dignified death.[92]
9. All older persons have the right to social security[93] and to access an appropriate level of humane and secure residential care, where the fundamental rights and freedoms of residents are recognised and protected.[94]
10. Older persons have the right to be free from arbitrary or unlawful interferences with his/her privacy, family, home or correspondence,[95] and respect for a person’s privacy must be maintained in institutional settings.
11. Older persons have the right to a family life, to marry and to have their family unit respected by others, including government agencies and officials.[96]
12. Older persons have the right to freely associate with others and to participate fully in the social and cultural life of their community.[97] This may include participation in voluntary work both before and following retirement, as well as the formation of, and engagement in, movements or associations of older persons.[98]
13. Older persons have the right to engage in work until such time as they choose to leave the workforce, to receive fair wages and equal remuneration for equal work and to work in safe and healthy working conditions.[99]
14. Older persons have the right to lifelong learning, to access and participate in education and training programs and to access the scientific, cultural, educational and spiritual resources of the community.[100]
15. Older persons have the right to take part in the conduct of public affairs, to vote, to stand for election and to be elected to parliament, and to have access, on equal terms, to public service.[101]
16. Older persons have the right to exercise freedom of thought, conscience and religion.[102]
17. Older persons have the right to freedom of opinion and expression and to seek, receive and impart information and ideas, particularly in respect of policies which affect their wellbeing or interests. Older persons should also be encouraged, and provided with opportunities, to share their knowledge and skills with younger generations. Adult persons also have the right to seek, and be provided with, personal information about him/herself held by government agencies of officials.[103]
This paper is an edited version of a paper presented at the 20[1]4 International Elder Law and Policy Conference, July 10 &11, 2014, John Marshall Law School, Chicago, Illinois.
* Senior Lecturer, Macquarie Law School; lecturer, Flinders Law School
1 Australian Research Network on Law and Ageing (ARNLA). ARNLA aims to provide a network of leading and emerging scholars, higher degree research students and community leaders with an interest in the interconnection between law and ageing in Australia. Central to the work of ARNLA is the promotion of human rights and freedoms for older persons, drawn from the principal international instruments concerning older persons – the UDHR, ICCPR, ICESCR, CRPD and the UN Principles for Older Persons. For further information on ARNLA please contact the authors.
[2] The ARNLA draft Charter is appended to this article. Comments on the Draft Charter are welcomed by the authors.
[3]Blomley v Ryan [1956] HCA 81; (1954) 99 CLR 362.
[4]Banks v Goodfellow (1870) LR5 QB, 549.
[5]Marriage Act 1961 (Cth) s 238(1)(d).
[6]Commonwealth Electoral Act 1918 (Cth) s 93(8).
[7]Crimes Act 1900 (NSW) s 61HA(4)(a).
[8]Secretary, Department of Health and Community Services v J.W.B. and S.M.B. [1992] HCA 15; (1992) 175 CLR 218 ('Marion's Case').
[9]Only those people eligible to vote can become a member of parliament.
[10]Alzheimer's Australia, Statistics, Summary of Dementia Statistics in Australia <http://www.fightdementia.org.au/understanding-dementia/statistics.aspx>
[11]Marshall B Kapp, 'Evaluating Decisionmaking Capacity in the Elderly' (1990) 2 Journal of Elder Abuse & Neglect 15
[12]Law Society of New South Wales, 'A Practical Guide for Solicitors: When a client’s capacity is in doubt' (Law Society of New South Wales, 2009) <http://www.lawsociety.com.au/cs/groups/public/documents/internetcontent/023880.pdf> 21.
[13][1954] HCA 17; (1954) 91 CLR 423.
[14] see Victorian Law Reform Commission, 'Guardianship Final Report 24' (Victorian Law Reform Commission, 2012), ch7 for an outline of varying legal tests for capacity applied in Australia.
[15]See for instance Paul Applebaum and Thomas Grisso, 'Assessing Patient's Capacities to Consent to Treatment' (1988) 319 New England Journal of Medicine 1635; Natalie Banner, 'Can Procedural and Substantive Elements of Decision-Making be Reconciled in Assessments of Mental Capacity' (2013) 9(1) International Journal of Law in Context 71; Penelope Brown et al, 'Assessments of Mental Capacity in Psychiatric Inpatients: A Retrospective Cohort Study' (2013) 13 BMC Psychiatry <http://www.biomedcentral.com/1471-244X/13/115> .
[16]Michael Bach and Lana Kerzner, 'A New Paradigm for Protecting Autonomy and the Right to Legal Capacity' (Law Commission of Ontario, 2010) <http://www.lco-cdo.org/en/disabilities-call-for-papers-bach-kerzner> .; Gerard Quinn, 'Personhood and Legal Capacity, Perspectives on the Paradigm Shift of Article 12 CRPD' (2010) Paper Presented at the Conference on Disability and Legal Capacity under the CRPD, Harvard Law School <http://www.inclusionireland.ie/content/page/capacity> .
[17]See Borthwick v Carruthers [1787] EngR 75; (1787) 99 ER 1300; Re Cumming [1852] EngR 427; (1852) 42 ER 660 at 668.
[18]Guardianship and Administration Act 2000 (Qld) sch 1 pt 1 cl 1; Guardianship and Administration Act 1990 (WA) s 4(3). Bucknall v Guardianship and Administration Tribunal (No 1) [2009] QSC 128; [2009] 2 Qd R 402 [21–6], [43].
[19]Guardianship and Administration Act 1986 (Vic) s 3 (definition of ‘disability’); Guardianship and Management of Property Act 1991 (ACT) s 5; Guardianship Act 1987 (NSW) s 3 (definition of ‘person in need of a guardian’ Guardianship and Administration Act 1993(SA) s 3 (definition of ‘mental incapacity’); Guardianship and Administration Act 1990 (WA) s 3 (definition of ‘mental disability’); Guardianship and Administration Act 1995 (Tas) s 3 (definition of ‘disability’); Adult Guardianship Act (NT) s 3(1) (definition of ‘intellectual disability’).
[20]Guardianship and Administration Act 1995 (Tas) ss 20 (1)(b), 51(1)(b); Guardianship and Administration Act 1990 (WA) ss 43(1)(b)(ii),Adult Guardianship Act (NT) s 3(1)Guardianship and Administration Act 1986 (Vic) ss 3 (definition of ‘disability’), 22(1)(a)–(b), 46(1)(a)(i)–(ii); Guardianship and Management
[21]Guardianship and Administration Act 2000 (Qld), Schedule 4.
[22]Guardianship and Administration Act 2000 (Qld) s 5(c).
[23]Guardianship and Management of Property Act 1991 (ACT) s 6A.
[24]XYZ v State Trustees Ltd [2006] VSC 444 (22 November 2006) [54]-[59].
[25]Marshall Kapp, 'Older Clients With Questionable Legal Competance: Elder Law Practitioners and Treating Physicians' (2011) 37 William Mitchell law review 99; Charlotte Emmett et al, 'Homeward bound or bound for home? Assessing the capacity of dementia patients to make decisions about hospital discharge: Comparing practice with legal standards' (2013) 36(1) International journal of Law and Psychiatry 73; C. Peisah, Luxenberg, J., Liptzin, B., Wand, A.P., Shulman, K. and Finkel, S., 'Deathbed wills: assessing testamentary capacity in the dying patient' (2013) (November) International Psychogeriatrics 1.
[26]Kapp, above n 25, 105.
[27]Marshall B Kapp and Douglas Mossman, 'Measuring Decisional Capacity: Cautions on the Construction of a" Capacimeter"' (1996) 2 Psychology Public Policy and Law 73.
[28]Carmelle Peisah et al, 'Decisional Capacity: toward an inclusionary approach' (2013) 25(10) International Psychogeriatrics 1571, 1577.
[29]See for instance: Ozioma Okonkwo et al, 'Awareness of Deficits in Financial Abilities in Patients With Mild Cognitive Impairment: Going Beyond Self-Informant Discrepancy' (2008) 16(8) American Journal of Geriatric Psychiatry 650; Applebaum and Grisso, above n 15;Thomas Grisso et al, Evaluating Competencies, Forensic Assessments and Instruments (Kluwer Academic Publishers, 2 ed, 2003); Melissa Finucane and Christina Gullion, 'Developing a Tool for Measuring the Decision-Making Competence of Older Adults' (2010) 25(2) Psychology and Aging 271.
[30]James Lai and Jason Karlawish, 'Assessing the Capacity to Make Everyday Decisions: a Guide for Clinicians and an Agenda for Future Research' (2007) 15(2) The American Journal of Geriatric Psychiatry 101, 104.
[31]Marshall B Kapp, 'Older Clients with Questionable legal Competence: Elder Law Practioners and Treating Physicians' (2011) 37 William Mitchell law review 99, 105.
[32]Tom Beauchamp and James Childress, Principles of Biomedical Ethics (Oxford University Press, 6 ed, 2009) 115; see also Natalie Banner, 'Unreasonable Reasons: Normative Judgements in the Assessment of Mental Capacity' (2012) 18(5) Journal of Evaluation in Clinical Practice 1038.
[33]Emmett et al, above n 25, 77.
[34]Ibid.
[35]C Umapathy et al, 'Competency Evaluations on the Consultation-Liaison Service: Some Overt and Covert Aspects' (1999) 40(1) Psychosomatics 28.
[36]John Chesterman, 'Capacity in Victorian Guardianship Law: Options for Reform' [2010] MonashULawRw 27; (2010) 36(3) Monash University Law Review 84.
[37]Rule 8, Australian Solicitors’ Conduct Rules (2011).
[38]Goddard Elliott v Fritsch [2012] VSC 87.
[39]Office of the Adult Guardian, Capacity Guidelines for Witnesses of Enduring Powers of Attorney (June 2005); Law Society of New South Wales, 'Client Capacity Guidelines: Civil and Family Law Matters' (2003) 41(8) (September) Law Society Journal 50; Law Society of South Australia, 'Client Capacity Guidelines South Australia' (2012) <http://www.lawsocietysa.asn.au/PDF/ClientCapacityGuidelines.pdf> .
[40]Law Council of Australia, Australian Solicitors' Conduct Rules 2011 and Commentary, (2013), r8.
[41]Ibid, commentary to rule 8, 7.
[42]NSW Toolkit; Capacity Assessment Principles”; Law Society of New South Wales, above n19, 27.
[43]Law Society of South Australia, above n 37, 11
[44] Article 16 of the International Covenant on Civil and Political Rights (opened for signature 16 December 1966, 999 UNTS 171 (entered into force 23 March 1976) provides: “Everyone shall have the right to recognition everywhere as a person before the law.”
[45]Articles 16 & 26, ICCPR; Principle 12, UN Principles for Older Persons, Article 12 CRPD. The authors note that in some jurisdictions the term competence is used instead of capacity, however in Australia the two terms are usually synonymous.
[46]Convention on the Rights of Persons with Disabilities, opened for signature 13 December 2006, 2515 UNTS 3 (entered into force 3 May 2008).
[47]Convention on the Rights of Persons with Disabilities: Declarations and Reservations (Australia), opened for signature 30 March 2007, 999 UNTS 3 (entered into force 3 May 2008).
[48]Office of the High Commissioner for Human Rights, 10th Session of the Committee on the Rights of Persons with Disabilities (12 November 2013) <http://www.ohchr.org/EN/HRBodies/CRPD/Pages/Session10Old.aspx> .
[49]Ibid.
[50]A complete copy of the Draft Charter has been inserted as an appendix to this article. Comments and suggestions in relation to the draft charter are welcomed by the authors.
[51]Articles 1 & 10, International Covenant on Civil and Political Rights (ICCPR); Article 1, International Covenant on Economic, Social and Cultural Rights (ICESCR); Principles 3, 14, 15, UN Principles for Older Persons; Articles 3 & 12 Convention on the Rights of Persons with Disabilities (CRPD).
[52]Sections 10(c) and (d), Advance Care Directives Act 2013 (SA).
[53]People with Disability Australia and NSW Mental Health Coordinating Council, ''Substitute Decision Making: Time for Reform', Submission to the NSW Legislative Council's Inquiry into Substitute Decision-making for People Lacking Capacity' (2009) ; Quinn, above n 16; Doug Surtees, 'What Can Elder Law Learn from Disability law?' in Israel Doron (ed), Theories on Law and Ageing, the Jurisprudence of Elder Law (Springer, 2009) 93.
[54]Quinn, above n 16.
[55]Edward Zalta, 'Stanford Encyclopedia of Philosophy' (2008) <http://www.science.uva.nl/~seop/archives/fall2008/entries/autonomy-moral/>
[56]John Christman, The Politics of Persons (Cambridge University Press, 2009) 155.
[57]Stephen Pepper, 'Autonomy, Community, and Lawyer's Ethics' (1990) 19 Capital University Law Review 939, 944.
[58]Margaret Hall, 'Mental Capacity in the (Civil) Law: Capacity, Autonomy, and Vulnerability' (2012) 58(1) McGill Law Journal 61, 88.
[59]Quinn, above n 16, 11.
[60]Articles 1 & 10, International Covenant on Civil and Political Rights (ICCPR); Article 1, International Covenant on Economic, Social and Cultural Rights (ICESCR); Principles 3, 14, 15, UN Principles for Older Persons; Articles 3 & 12 Convention on the Rights of Persons with Disabilities (CRPD).
[61] Sections 10(c) and (d), Advance Care Directives Act 2013 (SA).
[62]T Carney, ‘Guardianship, ‘Social’ Citizenship, and Theorising Substitute Decision Making Law’ in I Doren and A Soden ‘Beyond Elder Law:New Directions in Law and Ageing’ (Springer, 2012), 17; Office of the Public Advocate (South Australia)(2012) Annual Report, 58; Office of the Public Advocate, 'A Journey Towards Autonomy? Supported Decision-Making in Theory and Practice' (Queensland Department of Justice and Attorney General, 2014)
[63]Michelle Browning, Christine Bigby and Jacinta Douglas, 'Supported Decision Making: Understanding How its Conceptual Link to Legal Capacity is Influencing the Development of Practice' (2014) 1(1) Research and Practice in Intellectual and Developmental Disabilities 34, 34.
[64]For example; sufficient information about the decision and its ramifications, suitable timing, familiar surroundings, good lighting, reduced background noise, lack of thirst or hunger, appropriate medication if required. See Gemma Smyth, 'Mediation in Cases of Elder Abuse and Mistreatment. The Case of University of Windsor Mediation Services' (2011) 30 Windsor Review of Legal and Social Issues 121, 137; Erica Wood, 'Dispute Resolution and Dementia: Seeking Solutions' (2001) 35(2) Georgia Law Review 785, 812; Colleen Getz, 'Accommodating People with Disabilities, A Reference Guide for Mediators' (British Columbia Mediator Roster Society, 2009) <http://www.mediatebc.com/PDFs/1-23-Resources-%28For-Mediators%29/AccommodatingHandbook-web.aspx> .
[65]Peisah et al, above n 27, 10.
[66]For a comprehensive explanation of the various supported decision making models see Qld Office of the Public Advocate, A Journey Towards Autonomy? Supported Decision-Making in Theory and Practice, (2014).
[67]Robert Dinerstein, 'Implementing Legal Capacity Under Article 12 of the UN Convention on the Rights of Persons with Disabilities: The Difficult Road From Guardianship to Supported Decision-Making' (2012) 19(2) Human Rights Brief 8, 10.
[68]S Beamer and M Brookes, Making Decisions: Best Practice and New Ideas for Supporting People with High Support Needs to Make Decisions (Values into Action, London, 2001); Jo Watson, Submission No 19 to the Victorian Law Reform Commission, Review of the Guardianship and Administration Act 1986, May 2010, 10.
[69]Terry Carney and Fleur Beaupert, 'Public and Private Bricolage - Challenges Balancing Law, Services and Civil Society in Advancing CRPD Supported Decision-Making' [2013] UNSWLawJl 9; (2013) 36 University of New South Wales Law Journal 175, 200-201, Shih-Ning Then, 'Evolution and Innovation in Guardianship Laws: Assisted Decision-Making' [2013] SydLawRw 6; (2013) 35 Sydney Law Review 133; Nina Khon, Jeremy Blumenthal and Amy Campbell, 'Supported Decision-Making: A Viable Alternative to Guardianship' (2013) 117(4) Penn State Law Review 1111, 1112, 1130; Office of the Public Advocate, 'A Journey Towards Autonomy? Supported Decision-Making in Theory and Practice' (Queensland Department of Justice and Attorney General, 2014), 30.
[70]Carney and Beaupert, above n 69, 200.
[71]Representation Agreement Act, RSBC 1996, c 405, s 16.
[72]Representation Agreement Act, RSBC 1996, c 405, s 16 (8)(b)(ii).
[73]Office of the Public Advocate (South Australia) 58‐59.
[74]Surtees, above n 51.
[75]Australian Law Reform Commission, Review of Equal Recognition Before the Law and Legal Capacity for People with Disability, 2013 (At the time of writing this report had been presented to the Attorney General but had not yet been released).; Victorian Law Reform Commission above n14. Queensland law Reform Commission, A Review of the Queensland Guardianship Laws, 2010.
[76] Victorian Law Reform Commission, above n3, Recommendation 27,122.
[77]Ibid, Recommendation 29,123.Based on the model in Ontario and Alberta.
[78]Advance Care Directives Act 2013 (SA) Section 45(5)
[79] Ibid ss 45 & 46; The Advance Care Directives and Guardianship jurisdictions were conferred on the South Australian Civil and Administrative Tribunal (SACAT) by the Statutes Amendment (SACAT) Bill 2014 (SA). The SACAT will commence hearing these matters in March 2015 replacing the former Guardianship Board.
[80]Advance Care Directives Act 2013 Section 11(3).
[81] Ibid Section 7.
[82] Articles 1 & 10, International Covenant on Civil and Political Rights (ICCPR); Article 1, International Covenant on Economic, Social and Cultural Rights (ICESCR); Principles 3, 14, 15, UN Principles for Older Persons.
[83] Article 12, ICCPR; Principle 6, UN Principles for OlderPersons.
[84] Article 7, ICCPR; CAT; Principle 17, UN Principles for OlderPersons.
[85] Article 9, ICCPR; Article 12, ICESCR; Principle 17, UN Principles for OlderPersons.
[86] Article 17, Universal Declaration of Human Rights; Articles 1, ICCPR and ICESCR.
[87] Article 2, ICCPR; Article 2, ICESCR; Principle 18, UN Principles for OlderPersons.
[88] Articles 16 & 26, ICCPR; Principle 12, UN Principles for OlderPersons.
[89] Articles 2 & 14, ICCPR; Article 2, ICESCR; Principle 12, UN Principles for OlderPersons.
[90] Article 6, ICCPR; Articles 11 & 12, ICESCR; Principles 1, 10-13, UN Principles for OlderPersons.
[91] See, The Prague Charter: Relieving Suffering, available at: http://wwww.avaaz.org/en (accessed 13 August 2013).
[92] See, Draft Strategy for Safeguarding Older South Australians 2014-2021, available at, http://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/about+us/reviews+and+consultation/draft+south+australian+strategy+for+safeguarding+older+people+2014-2021 (accessed 13 August 2013).
[93] Article 9, ICESCR;
[94] Principles 13 & 14, UN Principles for OlderPersons.
[95] Article 17, ICCPR; Principles 5, 10, 17, UN Principles for OlderPersons.
[96] Article 23, ICCPR; Article 10, ICESCR; Principles 10, 5, UN Principles for OlderPersons.
[97] Article 25, ICCPR; Article 15, ICESCR; Principles 7, 8, & 9, UN Principles for OlderPersons.
[98] Principle 9, UN Principles for OlderPersons.
[99] Articles 6 & 7, ICESCR; Principles 2 & 3, UN Principles for OlderPersons.
[100] Articles 13 & 15, ICESCR; Principles, 4, 15 & 16, UN Principles for OlderPersons.
[101] Article 25, ICCPR.
[102] Article 18, ICCPR.
[103] Article 19, ICCPR; Principles 4, 15, 16, UN Principles for Older Persons. This right is also supported by Freedom of Information legislation throughout Australia.
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