Australian Health Practitioner Self-Regulation

Australia's National Registration and Accreditation Scheme for Health Practitioners: A National Approach to Polycentric Regulation?' by Belinda Bennett, Terry Carney, Mary Chiarella, Merrilyn Walton, Patrick Kelly, Claudette Satchell and Fleur Beaupert in (2018) 40(2) Sydney Law Review argues that the National Registration and Accreditation Scheme (NRAS) for Australian health practitioners

represents not only an interesting case study in the development of a national approach to regulation within a federal legal system, but also an example of polycentric regulation given the complex and multilayered nature of health practitioner regulation in Australia. The article analyses the NRAS within the broader regulatory context for health practitioner regulation and the administration of public regulation more generally, and explores the challenges posed by polycentric regulation within a federal system.

The authors comment

On 1 July 2010, a new national model for registration and accreditation of Australian health practitioners began operation. The National Registration and Accreditation Scheme (‘NRAS’) was developed with the agreement of all the state and territory Ministers for Health. The NRAS initially encompassed 10 health professions — with an additional four professions included in the Scheme since 2012 and a fifth soon to join. National Boards were established for each regulated profession, and the Scheme is governed by new legislation: the Health Practitioner Regulation National Law (‘National Law’), contained in the Health Practitioner Regulation National Law Act 2009 (Qld). The National Law was initially introduced in, and adopted by, the Queensland Parliament. It was then adopted, in some cases with amendments, in each Australian state and territory under an applied laws approach or, in the case of Western Australia (‘WA’), through the enactment of mirror legislation. 

The development of a national approach to registration and accreditation of health practitioners in Australia represents an interesting case study in the development of a national approach to regulation within a federal legal system. However, the Scheme is also situated within a broader regulatory context for both health practitioner regulation and the administration of public regulation more generally. Considered in this context, the Scheme can be seen as an example of ‘polycentric’ regulation, where the regulatory landscape is populated by an increasingly complex array of regulatory bodies, agencies and objectives. 

This article analyses the national regulation of health practitioners in Australia in terms of the move towards a national system of regulation and the polycentric setting of that system. Part II addresses the polycentric nature of health practitioner regulation in Australia. Part III provides the background to the Scheme from the original recommendations of the Australian Government’s Productivity Commission in 2005, through to the simplification of legislation governing health practitioner regulation in Australia with the enactment of the National Law. Part IV discusses: the national approach to legislation through use of an applied laws approach; the impact of the retention of a co-regulatory approach in New South Wales (‘NSW’) and its introduction in Queensland; and the potential for regulatory innovation under both the previous state-based approach to regulation and under the new national approach. Part V revisits polycentric regulation by examining its implications for regulators, governments and the public.

Colanders

Posts in this blog have noted belief systems - legally recognised or otherwise - such as the Church of Kopimism, Scientology, the Universal Family. and Jediism, the latter discussed in works such as ‘Jediism: A Convergence of Star Wars Fan Culture and Salad Bar Spirituality’ by Markus Davidsen in (2011) 51 Die Filosoof, ‘I Am A Jedi: Star Wars Fandom, Religious Belief and the 2001 Census’ by Jennifer Porter in Matthew Kapell and John Lawrence (eds) Finding the force in the Star Wars Franchise (Peter Lang, 2006) 95 and The 2001 Census, Religion and the Jedi (Australian Bureau of Statistics, 2001). There has been legal disagreement about the status of Pastafarianism, aka adherence to the parodic Church of the Flying Spaghetti Monster.

New Zealand for example has attracted attention for permitting adherents to officiate as marriage celebrants. Some jurisdictions have permitted adherents to wear a colander as a head covering when photographed for driver licence photo identity cards. The Netherlands has adopted a different stance.

The Guardian reports that the council of state, that nation's highest court,  has ruled that Pastafarianism is not a religion and accordingly dened  law student Mienke de Wilde the right to wear a colander on her head in her passport and driving licence photo. Off to the European court of human rights?

Driver photo IDs featuring the colander indicia are found in Victoria, New South Wales, Austria and other jurisdictions. (Australia does not permit the colander on the biometric photos in passports and, as noted in a post on Emanuel and Anor v State of Queensland [2011] QCAT 731, requires people to provide a facial image as a condition for licensed driving of motor vehicles, with the photo ID driver licence card serving as the default national identity document for most Australian adults.)

The court appears to have concluded that Pastfarianism was parodic of conventional religions, noting its foundation in 2005 as a response to Christian fundamentalists advocating the teaching of creationism in US schools. Critics demanded 'equal time' in science classrooms for 'Flying Spaghetti Monsterism', with adherents claiming to  worship an invisible and undetectable god called the Flying Spaghetti Monster, wear colanders on their heads in homage to that deity, eat pasta, "be nice to all sentient beings" and recognise pirates as the original Pastafarians.

De Wilde is reported as stating that although the church was humorous that did not mean it was not “very serious in what it stands for”.

I can imagine that it all looks very odd if you don’t believe. But that’s the case with many faiths if you don’t believe in them – people who walk on water or divide themselves in two, for example. I find other religions unbelievable.

Consistent with Australian jurisprudence, the court considered the obligations of adherents. It is reported to have commented

It may be the case that the colander is considered a holy object for Pastafarians, worn in honour of the Flying Spaghetti Monster but there is no obligation to do so.  In fact, Pastafarianism has no obligations or restrictions. De Wilde has said she wears her colander because she sees it as duty but it is an individual choice.

 “It is important to be able to criticise religious dogma freely through satire but that does not make such criticism a serious religion.”

NSW Trusts Report

The NSW Law Reform Commission report Laws relating to beneficiaries of trusts was released at the end of July. Its terms of reference were to 'review certain aspects of the law of trusts in NSW and report on whether'

• there is a need to enact statutory provisions to limit the circumstances if any in which the beneficiaries of trusts, as beneficiaries, should be liable to indemnify the trustee or creditors of the trust, if the trustee fails to satisfy obligations of the trust, or remove such liability 
• it is appropriate for the liability of investors in unit trusts to be limited to the amount (if any) unpaid on their units in the same way that the liability of investors in shares is limited to the amount (if any) unpaid on their shares. 

The Commission was to have regard to:

•  the perceived uncertainty of the case law on the liability of trust beneficiaries in New South Wales and elsewhere 
• the widespread use of trusts in commercial contexts as well as in the community generally 
• the need for safeguards to ensure that any legislation limiting or removing such liability does not support the avoidance of responsibility for insolvent trading. 

The Commission was also to

• propose the terms in which any legislation should be enacted, and 
• to consult and report on whether New South Wales should adopt the recommendations of the Victorian Law Reform Commission's 2015  Trading Trusts - Oppression Remedies report. 

The report features the following recommendations

Liability of beneficiaries 

Recommendation 2.1 The Trustee Act 1925 (NSW) should be amended to provide that: 

(1) Unless the beneficiary has otherwise expressly agreed, the beneficiary is not, as a beneficiary, liable for, or to indemnify the trustee in respect of any act, default, obligation or liability of the trustee. 

(2) This does not affect a beneficiary’s liability for unpaid calls (if any) under the terms of the trust, or the beneficiary’s liability in any other capacity. 

Oppression remedies 

Recommendation 3.1 Oppression remedies available to shareholders under company law should not be extended to beneficiaries of trading or other trusts under the law of trusts.

The report states

 We published the terms of reference on our website and sought preliminary submissions. We received eight submissions, which are listed in Appendix A and published on our website. 

In October 2017, we released a consultation paper (CP 19) setting out preliminary views on the two questions. We received six submissions in response, which are also listed in Appendix A and published on our website. 

We convened a roundtable of interested experts in the field on 2 March 2018. A list of participants is set out in Appendix B. Following the roundtable, one further submission was received from a participant, which is also listed in Appendix A.

The Commission outlines the report

Chapter2 addresses the reference on beneficiary liability. The reference is motivated by a long-standing issue arising from a Privy Council decision more than a century ago, under which a beneficiary may be held personally liable to indemnify a trustee. Since then, several proposals for reform or clarification of the law, in the context of managed investments, have been made but not implemented in a number of Australian jurisdictions. We propose that the effect of that decision be reversed by amending the Trustee Act 1925 (NSW) (“Trustee Act”). 

Oppression remedies for beneficiaries of trading trusts 

Chapter 3 addresses the reference on the remedy for oppression, and considers the recommendation of the Victorian Law Reform Commission (“VLRC”) to extend the oppression remedy available to members of a company under the Corporations Act 2001 (Cth) (“Corporations Act”) to beneficiaries of trading trusts. 

We are not persuaded that there is a sufficient case for providing a similar discretionary remedy for oppression in the context of the law of trusts. Such a remedy would be inconsistent with a fundamental feature of a discretionary trust ̶ namely, that the trustee has a discretion to discriminate between beneficiaries. Having such a remedy available for some trusts but not others is not desirable because there would be difficulty in identifying those trusts to which it should apply. Moreover, we consider that the law already provides adequate remedies for control of a trustee. 

There are advantages in having consistency across Australian states and territories in laws affecting trading trusts. This is why we carefully considered the VLRC recommendation before declining to adopt it for the above reasons. The VLRC Report has not yet been accepted or adopted in Victoria; so at least at this stage no issue arises from any difference between the law in Victoria and NSW. 

We note that, to the extent that consistency is not achieved by an appellate decision, Commonwealth legislation amending the Corporations Act could achieve this outcome.

WA Missing Medications Inquiry

The Western Australia Corruption and Crime Commission's Report on serious misconduct risks around drugs in hospitals follows its 2017 report on the Supply and Management of Schedule 8 Controlled Drugs at Certain Public Hospitals in Western Australia, triggered by the repeated theft of drugs by a senior pharmacist at Fiona Stanley Hospital (FSH).

The new report is

a supplement to the Commission's June 2017 report. The purpose of this report is to consider more broadly the issue of theft and misuse of dangerous and addictive pharmaceutical drugs by employees of WA Health, and provide advice and recommendations about ways to prevent serious misconduct. The Boards of WA Health's five Health Service Providers are responsible for the management and security of Schedule 8 and Schedule 4 Restricted drugs held in their hospitals and other facilities, and for mitigating the risks that can arise from the theft and abuse of these drugs. This report's primary purpose is to assist those Boards in their management of the serious misconduct risk inherent in discrepancies of dangerous drugs.

The Commission states

This report analyses notifications received from WA Health about discrepancies for Schedule 8 and Schedule 4 Restricted drugs for the period 1 July 2013 to 30 June 2017 from three major metropolitan hospitals, Royal Perth Hospital (RPH), SCGH, and Fremantle Hospital (FH). These hospitals reported the majority of drug discrepancies. The analysis does not include FSH as issues relating to drug security procedures there were considered in the Commission's June 2017 report. There are common themes or patterns of drug discrepancies arising from the notifications which might guide WA Health in its efforts to deal with this problem. Relevant documents including legislation, WA Health policies and investigation reports have been considered. 

A literature review has been conducted of research nationally and internationally on drug security in hospitals, drug addiction among health professionals and the misuse of pharmaceutical drugs in the community. In preparing this report, the Commission has referred to several reports on the same, or similar topics. These include the following:

• A report by the Commission titled Misconduct Handling Procedures in the Western Australian Public Sector: WA Health, tabled in Parliament on 22 April 2010. This report was based on interviews with a wide range of WA Health employees and a survey. 

• A report by the WA Auditor General titled Pharmaceuticals: Purchase and Management of Pharmaceuticals in Public Hospitals, Report 7, June 2012. 

• Inquests by the WA Coroner in July 2013 into the separate deaths of two WA Health nurses in 2009 and 2010. The inquests revealed that both nurses died from an overdose of drugs, almost certainly accessed from the hospitals at which they worked. 

• The Commission's June 2017 report was based on the investigation by the Commission of the theft of drugs from the pharmacy at FSH.

The investigation included examinations with senior WA Health officers and site inspections. The Commission provided a draft of this report to the Department of Health. Representations have been received from the Director General, from the Medicines and Poisons Regulation Branch of the Department, and from the five Health Service Providers. The Commission thanks those agencies for their comments. Where relevant, they have either been incorporated into this report, or are noted.

It offers the following conclusions

While the total number of drug discrepancies notified to the Commission by WA Health is small compared to the total number of drug transactions in hospitals, it appears that theft and misuse of dangerous drugs by employees is an ongoing problem. WA Health's policies guiding employees on the management and recording of dangerous drugs have in practice, often not been complied with or not enforced. 

As a result, there have been gaps in the records and shortfalls in the security of drugs, which means that in many of the cases notified to the Commission, WA Health has been unable to determine whether a drug discrepancy is accidental or the result of theft and, if so, who was responsible. Drug discrepancies and instances of drug related behaviour have sometimes been investigated by health professionals or human resources officers rather than by professional investigators. This can increase the difficulty in identifying the reason for the discrepancy and, if there has been a theft, in collecting evidence which will enable the person responsible to be identified and dealt with by a criminal or disciplinary process. WA Health has been inclined to deal with employees with drug offending behaviour from a welfare perspective, which may not sufficiently prevent future risks to patients and colleagues.

The report in discussing concerns about failure to notify comments

Notifications were made by WA Health for matters occurring at 50 health service sites. Given that there are 85 hospitals and a large number of other WA Health sites, either there are many sites at which there have been either no unexplained drug discrepancies in the four year period, or possible under-reporting. Many WA Health sites are small, with limited staff and with lower stocks of dangerous drugs. 

However, evidence of under-reporting at WA Health has been identified by the Commission in the past. During the Commission's 2009 review, some employees described a workplace attitude that, because employees worked long demanding hours in difficult conditions, there was a sense of entitlement about taking items, including drugs. 

Employees also admitted they had previously withheld information about possible misconduct because of loyalty to co-workers and fear of retribution:

... staff know that if you 'blow the whistle' you know they won't make life easy for you ... staff would put their head in the sand ... there's a fear of retribution when it comes to reporting misconduct ...

Research has attempted to explore the underlying reasons why health professionals are inclined not to report workplace misconduct. A 2004 study examining a case in which four nurses went public with their concerns about hospitals in NSW, found that although nurses were obligated by codes of ethics to take action to protect patient safety, there are risks. It referred to other case studies recorded by the same author (a Professor of Nursing) and said 'Nurses who blow the whistle often end up with their careers and lives in tatters'. 

Possible reasons for health professionals not reporting their co-workers can include reluctance to tarnish their employer or the health system, fear of the judgment of others, of implicating a friend, or of losing their job. 

A current review of WA Health's investigation reports suggests that WAHealth may still be an environment where there is little encouragement or support for employees to either understand the seriousness of drug related misconduct, or to report it. 

For example, in one notification, it was explained that a nurse suspected to be linked to a number of drug discrepancies had repeatedly displayed past behaviours which raised a number of his colleagues' concerns:

• He had circumvented drug handling policies, such as drawing up drugs in excess amounts without witnesses. 

• He deliberately disobeyed managerial restrictions relating to drug access and entered medical procedure rooms when allocated duties elsewhere. 

• He consistently requested to go into procedure rooms and be involved in duties involving drugs. 

• He was present shortly before drug substitutions and discrepancies were detected. 

• He drew up syringes of fentanyl well before they were required for a medical procedure and without another nurse present, which is against policy. 

• He had been seen near the sharps container removing syringes, some of which would contain unused amounts of fentanyl and midazolam. 

• He was constantly seen staring at drug cabinets. 

• He forged a medical certificate to cover his absences. 

• On one occasion, while on duty, he appeared drowsy and incoherent and then lost consciousness. He was admitted to the emergency department. When his next of kin was advised, they asked "has he been self-medicating again?". On this day, two crushed ampoules containing fentanyl and midazolam were discovered without any evidence of an accidental spillage. 

• He called in sick when a staff meeting about suspected internal drug theft was organised. His close friend, who also worked in the health service, asked questions during the staff meeting such as "what would happen to the person concerned if caught?".

 A clinical consultant said she was approached by "many nurses and a few of the doctors" who expressed their suspicions about the nurse. She went to the Acting Director of Nursing who she believes took the matter up but was told that the nurse was to "remain where he was". The Commission understands that the nurse was reprimanded and warned but remained employed and accredited. 

The recent investigation by the Commission of a WA Health senior pharmacist for stealing Schedule 8 drugs from FSH also demonstrated the risk of colleagues not having the confidence to treat discrepancies as misconduct:

"Didn’t tell them I was suspecting because I find it's not appropriate to point finger. ... It's also a matter of trust. You know we trust them so much ... it’s a highly trusted job. ... I was scared about my - the pharmacists health. I thought that he might kill himself. I thought maybe he's an addict ... and we need to help him. The first thinking was oh my god we need to help him, he, you know, could kill himself   overdosing, because we hear every now and then in news that, okay, this person killed themselves. You know, people working in hospitals."

In a hospital environment, there is a risk that disparities of power between employees may influence internal reporting. Lower level staff may be less inclined to report higher level staff, and certain professionals may be less likely to be questioned. It is important that WA Health recognises this risk when developing and implementing strategies to encourage the reporting of drug related misconduct. 

Regardless whether an agency has an effective process for reporting externally to the Commission or to police, unless employees are prepared to report internally, the agency will not be aware of the issues. 

While the Commission understands the desire for colleagues and mangers to think first about the welfare of the employee, suspected theft of, and misuse of drugs may be serious misconduct and must be notified to the Commission.

NSW Guardianship Recommendations

Recommendations in the NSW Law Reform Guardianship report noted in the preceding post are

4. A new assisted decision-making framework 

4.1 A new Act 

(1) There should be a new Act to provide for supported decision-making and substitute decision-making called the Assisted Decision-Making Act (“the new Act”). 

(2) The new Act should replace the Guardianship Act 1987 (NSW) and the enduring power of attorney provisions in the Powers of Attorney Act 2003 (NSW). 

(3) The new Act should include: (a) statutory objects and general principles that reflect the values upon which the Act is based and guide its interpretation and implementation (b) principles to guide the assessment of decision-making ability (c) assisted decision-making arrangements and the mechanisms for putting these in place, including processes for personal appointments, court and tribunal appointments and default arrangements (d) principles to guide people acting under the new Act (e) the roles and responsibilities of people acting under the new Act (f) safeguards that ensure accountability of people acting under the new Act, including monitoring and review of orders and decisions, and (g) the functions and powers of a new Public Advocate role. 

4.2 Language and structure of the Act 

The new Act should contain language and a structure that are as simple and as accessible as possible. 

4.3 Key terms 

The new Act should provide: (1) The Guardianship Division of the NSW Civil and Administrative Tribunal is to be renamed the Assisted Decision-Making Division (“the Tribunal”). (2) When someone appoints another person to make personal, financial, healthcare and/or restrictive practices decisions on their behalf, that person is to be referred to as an “enduring representative” and the person on whose behalf they act as a “represented person”. (3) A person appointed by the Supreme Court or Tribunal to make personal, financial, healthcare and/or restrictive practices decisions on behalf of someone else is to be referred to as a “representative” and the person on whose behalf they act as a “represented person”. (4) A person appointed by the Tribunal or under a support agreement to support someone else make decisions is to be referred to as a “supporter” and the person they support as a “supported person”. (5) The NSW Trustee and Guardian is to be renamed the NSW Trustee. (6) The Public Guardian is to be renamed the Public Representative. 

4.4 Personal decisions 

The new Act should provide: (1) A “personal decision” is a decision that relates to personal or lifestyle matters. (2) The following are examples of personal decisions: (a) where a person lives (b) who a person lives with (c) whether a person works and, if a person works, where and how the person works (d) what education and training a person undertakes (e) what kind of personal services the person receives (for example, in-home care, respite services, or occupational therapy) (f) whether a person applies for a licence or permit (g) day-to-day decisions about, for example, dress and diet (h) whether to consent to a forensic examination of a person (i) whether a person will go on a holiday and where, and (j) legal matters relating to a person’s personal care. 

4.5 Financial decisions 

The new Act should provide: (1) A “financial decision” is a decision about one or more aspects of a person’s property. (2) The following are examples of financial decisions: (a) paying maintenance and accommodation expenses (including future expenses) for a person and the person’s dependants (b) paying a person’s debts and expenses (c) receiving and recovering money payable to a person (d) carrying on a person’s trade or business (e) performing contracts entered into by a person (f) discharging a mortgage over a person’s property (g) paying rates, taxes and other outgoings for a person’s property (h) insuring a person or their property (i) preserving or improving a person’s property (j) buying and disposing of property (k) dealing with land for a person (l) making or continuing investments for a person (m) making gifts and donations (n) executing documents (for example, contract for sale of goods or property, signing a lease, and authorising bank payments) (o) undertaking a transaction for a person involving the use of the person’s property as security for the benefit of the person (p) withdrawing money from, or depositing money into, a person’s account with a financial institution (q) taking up the rights to the issue of new shares to which the person is entitled, and (r) making decisions on legal matters relating to a person’s finances or property (for example, bankruptcy, signing contracts or deeds, and retaining a lawyer for legal advice).   

4.6 Healthcare decisions 

The new Act should provide: (1) A “healthcare decision” is a decision about a person’s healthcare. (2) “Healthcare” has the meaning set out in Recommendation 10.4. 

4.7 Restrictive practices decisions 

The new Act should provide that: (a) A “restrictive practices decision” is a decision to approve or disapprove the use of restrictive practices on a person. (b) “Restrictive practice” means any practice or intervention that has the effect of restricting the rights or freedom of movement of a person. 

5. Objects and principles 

5.1 Statutory objects 

The new Act should include a statement of statutory objects that sets out that: (a) the Act is founded on the principle that people in need of decision-making assistance have the same human rights as all members of the community and that the State and the community have a responsibility to facilitate the exercise of those rights, and (b) the objects of the Act are accordingly to: (i) implement the purposes and principles of the United Nations Convention on the Rights of Persons with Disabilities, and (ii) promote the independence and personal and social wellbeing of people in need of decision-making assistance and provide safeguards in relation to the activities governed by the Act. 

5.2 General principles 

The new Act should provide that it is the duty of everyone exercising functions under the Act to observe the following principles with respect to people in need of decision-making assistance: (a) Their will and preferences should be given effect wherever possible, in accordance with Recommendation 5.4. (b) They have an inherent right to respect for their worth and dignity as individuals. (c) Their personal and social wellbeing should be promoted. (d) They have the right to participate in and contribute to social and economic life. (e) They have the right to make decisions that affect their lives (including decisions involving risk) to the full extent of their ability to do so and to be assisted in making those decisions if they want or require assistance. (f) They have the right to respect for their age, sex, gender, sexual orientation, cultural and linguistic circumstances, and religious beliefs. (g) They should be supported to develop and enhance their skills and experience. (h) They have the right to privacy and confidentiality. (i) They have the right to live free from neglect, abuse and exploitation. (j) Their relationships with their families, carers and other significant people should be recognised. (k) Their existing informal supportive relationships should be recognised. (l) Their rights and autonomy should be restricted as little as possible. 

5.3 Additional general principles for Aboriginal people and Torres Strait Islanders 

The new Act should provide that everyone exercising functions under this Act with respect to a person in need of decision-making assistance who is an Aboriginal person or Torres Strait Islander must: (a) to the extent that it is practicable and appropriate to do so, act in accordance with that person’s customary law, culture, values and beliefs (b) recognise that Aboriginal people and Torres Strait Islanders have a right to respect and acknowledgment as the first peoples of Australia and for their unique history, culture and kinship relationships and connection to their traditional land and waters (c) recognise that many Aboriginal people and Torres Strait Islanders may face multiple disadvantages (d) address that disadvantage and the needs of Aboriginal people and Torres Strait Islanders, and (e) work in partnership with Aboriginal people and Torres Strait Islanders in need of decision-making assistance to enhance their lives. 

5.4 Determining a person’s will and preferences 

The new Act should state that anyone exercising functions under it should approach the task of giving effect to a person’s will and preferences wherever possible, as follows: (a) First, to be guided by the person’s expressed will and preferences (including a valid advance care directive) wherever possible. (b) If these cannot be determined, to be guided by the person’s likely will and preferences. These may be determined by the person’s previously expressed will and preferences, and by consulting people who have a genuine and ongoing relationship with the person and who may be or have been aware of the person’s will and preferences. (c) If these too cannot be determined, to make decisions that promote the person’s personal and social wellbeing. (d) If giving effect to a person’s will and preferences creates an unacceptable risk to the person (including the risk of criminal or civil liability), to make decisions that promote the person’s personal and social wellbeing. (e) Regardless, a person’s decision to refuse healthcare in a valid advance care directive must be respected if that refusal is clear and extends to the situation at hand. 

6. Decision-making ability 

6.1 Definition of decision-making ability 

The new Act should provide that a person has decision-making ability for a particular decision if they can, when the decision needs to be made: (a) understand the relevant information (b) understand the nature of the decision and the consequences of making or failing to make that decision (c) retain the information to the extent necessary to make the decision (d) use the information or weigh it as part of the decision-making process, and (e) communicate the decision in some way. 

6.2 Presumption of decision-making ability 

The new Act should include a rebuttable presumption that a person has decision-making ability. 6.3 Determining decision-making ability The new Act should provide that: (1) Anyone who must determine whether a person lacks decision-making ability for the purposes of the new Act must be satisfied that the person is or has been assessed at a time and in an environment in which their decision-making ability can be assessed most accurately. (2) Anyone determining whether a person lacks decision-making ability should consider that: (a) decision-making ability is specific to the decision being made (b) inability to make a decision may be temporary or permanent and may fluctuate over time (c) decision-making ability may be different at different times (d) a person may develop, gain or regain decision-making ability, and (e) a person has decision-making ability for a matter if it is possible for the person to make the decision with practicable and appropriate support. (3) Anyone making a determination cannot conclude that a person does not have decision-making ability only because of one or more of the following: (a) the person’s age (b) the person’s appearance (c) an aspect of the person’s behaviour (or manner) (d) the person’s political, religious, or philosophical beliefs (e) the fact that people may disagree with the person’s decisions (on any grounds, including moral, political or religious) or think the person’s decisions are unwise (f) the fact that the person has a physical or mental condition (g) the fact that a person is a forensic patient, or may become a forensic patient (h) the person’s methods of communication (i) the person’s sex, gender, sexual preference or sexual conduct (j) the person’s cultural and linguistic circumstances, or (k) the person’s history of drug or alcohol use. 

6.4 Determining decision-making ability of Aboriginal people and Torres Strait Islanders  

The new Act should provide that, to the extent that it is appropriate and practicable to do so, anyone who must determine the decision-making ability of an Aboriginal person or Torres Strait Islander should have regard to: (a) any cultural or linguistic factors that may impact on an assessment of the person’s decision-making ability, and (b) any other relevant considerations pertaining to the person’s culture. 

7. Supported decision-making 

7.1 Eligibility to appoint a supporter under a support agreement 

The new Act should provide that a person may appoint a supporter through a support agreement if the person making the appointment: (a) is at least 18 years of age (b) has decision-making ability to enter the agreement, and (c) is making the agreement voluntarily. 

7.2 Eligibility for appointment as a supporter under a support agreement 

The new Act should provide that a person is not eligible to be appointed as a supporter if: (a) the person is under 16 years of age (b) they are to assist with financial decision-making and they have been bankrupt or been found guilty of an offence involving dishonesty, unless they have recorded this in the support agreement, or (c) they are the Public Representative or the NSW Trustee.   

7.3 Making a support agreement 

The new Act should provide: (1) that a support agreement must be in a prescribed form and be signed by the person making the appointment and the proposed supporter accepting the appointment (although not necessarily at the same time or in the presence of each other). (2) for an eligible signer, where required, to sign for the person in the person’s presence and at their direction. (3) for eligible witnesses to witness the signature, and certify that: (a) they explained the effect of the agreement to the person making the agreement before it was signed, and (b) the person making the agreement signed voluntarily and appeared to have decision-making ability in relation to the agreement. 

7.4 Referral to the Public Advocate 

The Tribunal may refer parties to the Public Advocate to facilitate the development of a support agreement. 

7.5 Tribunal may declare appointment has effect 

The new Act should provide that a supporter, a supported person, or other person with a genuine interest in the personal and social wellbeing of the supported person, may apply to the Tribunal for a declaration that an appointment under a person support agreement is valid. 

7.6 Application for a Tribunal support order 

The new Act should provide: (1) An application to the Tribunal for a support order may be made by: (a) the person to whom the order will apply (b) the Public Representative or the Public Advocate, or (c) a person with a genuine interest in the personal and social wellbeing of the person who is the subject of the application. (2) An application must specify the grounds upon which there is a need for an order. (3) As soon as practicable after making the application, the applicant must serve the application on each of the parties. (4) Before conducting a hearing into the application, the Tribunal must notify each party of the hearing’s time, date and location. (5) Failing to serve a copy of the application or a notice does not invalidate the Tribunal’s decision on the application. (6) The Tribunal may treat an application for a representation order, review of a support order, support agreement or enduring representation agreement as an application for a support order.   

7.7 Making a support order 

(1) The new Act should provide that, after conducting a hearing into an application, the Tribunal may appoint a supporter to assist the person if: (a) the person needing support (“the person”) is of or above the age of 18 (b) there are one or more decisions to be made (c) an eligible and suitable supporter is available (d) the person would have decision-making ability in relation to the decision(s) covered by the order if assisted by the proposed supporter (e) less intrusive and restrictive measures have already been considered and are either unavailable or not suitable (f) the proposed supporter consents to the appointment, and (g) the person consents to the appointment. (2) A support order must set out the supporter’s functions and any limits on those functions. 

7.8 Additional Tribunal considerations for orders about Aboriginal people and Torres Strait Islanders 

The new Act should provide that, to the extent that it is appropriate and practicable to do so, the Tribunal must, when determining whether a support order should be made for an Aboriginal person or Torres Strait Islander, have regard to: (a) the likely impact of the order on the person’s culture, values, beliefs (including religious beliefs) and linguistic environment (b) the likely impact of the order on the person’s standing or reputation in their indigenous community, and (c) any other relevant consideration pertaining to the person’s culture. 

7.9 Eligibility for appointment as a supporter under a support order 

The new Act should provide that the Tribunal may not appoint a person as a supporter under a support order if: (a) the person is under 16 years of age, or (b) they are the Public Representative or the NSW Trustee. 

7.10 Suitability for appointment as a supporter under a support order 

The new Act should provide: (1) In deciding whether a proposed supporter is suitable, the Tribunal must take into account: (a) the will and preferences of the person in need of decision-making assistance (“the person”), determined as set out in Recommendation 5.4 (b) the nature of the relationship between the proposed supporter and the person (c) the abilities and availability of the proposed supporter (d) whether the proposed supporter will be likely to act honestly, diligently and in good faith in the role (e) whether the proposed supporter has or may have a conflict of interest in relation to any of the decisions referred to in the order, and will be aware of and respond appropriately to any conflicts (f) whether the supporter would promote the person’s personal and social wellbeing (g) the person’s cultural identity, and (h) where the proposed supporter will assist with financial decision-making, whether they have been bankrupt or been convicted of a dishonesty offence. (2) A person should not be prohibited from appointment as a supporter on the basis that they will receive financial remuneration for their appointment. 

7.11 Effect of order on other appointments 

The new Act should provide that a support order (including an order of the Supreme Court to like effect) operates to suspend any support agreement in its entirety, unless the Tribunal or Court allows limited operation of the agreement. 

7.12 Functions of supporters 

The new Act should provide: (1) A supporter’s functions are determined by the support agreement or order and are limited to the following: (a) to communicate or assist the supported person in communicating their decisions to other people, and advocate for the implementation of the decision where necessary, and (b) to access, collect or obtain, or assist the supported person in accessing, collecting or obtaining any relevant personal information (including financial and health information) about the supported person in order to assist the supported person to understand the information. (2) A supporter is not authorised to: (a) make decisions on behalf of the supported person (b) exercise their functions without the supported person’s knowledge and consent, or (c) access, collect or obtain personal information about the supported person that the supported person would not be entitled to access, or collect or obtain personal information beyond that permitted by the agreement or order (as applicable). (3) Unless otherwise specified in the agreement or order, a supporter may, on behalf of a supported person, sign and do all such things as are necessary to give effect to any function under the agreement or order. 

7.13 Responsibilities of supporters 

The new Act should provide: (1) Supporters must: (a) observe the Act’s general principles (b) act honestly, diligently and in good faith and not coerce, intimidate or unduly influence the supported person (c) act within the conditions or limitations of the agreement or order (d) ensure that they identify and respond to situations where their interests conflict with those of the supported person, ensure the supported person’s interests are always the paramount consideration, and seek external advice where necessary (e) treat the supported person and important people in their life with dignity and respect (f) if they are assisting with financial decision-making, keep accurate records and accounts (g) respect the supported person’s privacy and confidentiality by: (i) only collecting personal information to the extent necessary for carrying out the supporter’s role, and (ii) only disclosing such information in circumstances permitted by Recommendation 14.3, and (h) notify the Public Representative, if the supported person no longer has the decision-making ability to be supported to make the relevant decision. (2) Supporters must sign an acknowledgement that they have read and understood these responsibilities. 

7.14 Types of decisions that can be made under a support arrangement 

The new Act should provide that a supporter may assist a person to make decisions including those about personal matters, financial matters, healthcare and restrictive practices. The support agreement or order should specify what decisions or types of decisions the supporter may make as well as any conditions or limitations. 

7.15 When support agreement or order has effect 

The new Act should provide that a support agreement or order has effect in relation to a decision to which it applies except for any period during which: (a) the supported person does not have decision-making ability for that decision even when assisted by the supporter, or (b) the agreement or order is terminated or suspended or has lapsed. 

7.16 Appointment of multiple supporters 

The new Act should allow a person or the Tribunal to appoint more than one supporter to assist a person, either together or separately, in relation to one or more functions. 7.17 Appointment of reserve supporters The new Act should allow a person or the Tribunal to appoint one or more reserve supporters to act if the original supporter dies, resigns or does not have the decision-making ability (temporarily or permanently) to act under the agreement or order. 

7.18 Resignation of a supporter 

The new Act should provide that a supporter may resign their appointment: (a) if the supported person understands the nature and consequences of the resignation, by giving notice in writing to the supported person, or (b) if the supported person does not understand the nature and consequences of the resignation, with the approval of the Tribunal. 

7.19 End or suspension of a support agreement or order 

The new Act should provide that: (1) A supported person may terminate, in writing, an appointment under a support agreement if the supported person: (a) has decision-making ability in relation to the agreement and its termination, and (b) terminates the agreement voluntarily. (2) A supported person may seek approval from the Tribunal to terminate a support order, if the supported person: (a) has decision-making ability in relation to the termination of the order, and (b) seeks the termination of the order voluntarily. (3) A support agreement or order lapses if the sole supporter appointed to carry out a function dies, or the end date is reached, or in any other circumstances specified in the agreement or order. (4) A support agreement or order does not lapse when a supporter dies if there is another supporter appointed to carry out the functions. (5) A support agreement or order is suspended, so far as it appoints a supporter, if the supporter becomes a person who does not have the decision-making ability to act as a supporter. (6) If a supported person becomes subject to a Tribunal representation order, any support agreement or order is suspended for the duration of the order, unless the Tribunal orders otherwise. 

7.20 Tribunal review of support agreements and orders 

The new Act should provide: (1) The Tribunal may review a support agreement or order on its own motion. (2) The Tribunal must review a support agreement or order if requested to do so by: (a) the supported person (b) the supporter (c) the Public Representative or Public Advocate (d) a person with a proper interest in the proceedings, or (e) a person with a genuine interest in the personal and social wellbeing of the supported person unless the request does not disclose grounds that warrant a review. (3) The Tribunal must, before carrying out the review, notify each party of the date, time and place of the review (although failure to do so will not invalidate a decision). (4) The Tribunal may order that the support agreement or order is suspended until the review is complete. 

7.21 Tribunal action on review 

The new Act should provide: (1) The Tribunal, when reviewing a support agreement, should consider, where relevant: (a) whether the person met the eligibility criteria for entering into the agreement, and (b) if the person did meet the eligibility criteria to enter into the agreement: (i) the fact that the supporter was chosen by the person (ii) whether the eligibility criteria for a supporter are still met, and (iii) whether the supporter is meeting their responsibilities and carrying out their required functions. (2) The Tribunal must, when reviewing a support order, have regard to whether: (a) there is still a need for a support order (b) the eligibility and suitability criteria for a supporter are still met, and (c) the supporter is meeting their responsibilities and carrying out their required functions (3) The Tribunal may, following its review, do any of the following to the agreement or order, in whole or in part: (a) confirm it (with the consent of the supported person) (b) vary it, including by appointing a replacement supporter who is suitable and eligible (c) suspend it, or (d) terminate it. (4) The Tribunal may make a fresh order in accordance with the new Act, including a representation order, to supersede the support agreement or order which has been suspended or revoked. 

8. Personal appointments of representatives 

8.1 Types of decisions an enduring representation agreement may cover 

The new Act should provide that: (1) A person may appoint an enduring representative or representatives through an enduring representation agreement. (2) An enduring representation agreement may apply to decisions including those about personal matters, financial matters, healthcare and restrictive practices. (3) The agreement should specify what decisions or types of decisions the enduring representative or representatives may make as well as any conditions or limitations. 

8.2 Eligibility to appoint an enduring representative 

The new Act should provide that a person may appoint an enduring representative through an enduring representation agreement if the person making the appointment: (a) is at least 18 years of age (b) has decision-making ability to enter into the agreement, and (c) is making the agreement voluntarily. 

8.3 Eligibility for appointment as an enduring representative 

The new Act should provide: (1) A person is not eligible to be appointed as an enduring representative if: (a) they are under 18 years of age (b) they (or their spouse, child, brother or sister) provide, for fee or reward, healthcare, accommodation or other support services to the appointing person (c) they are to be given a financial function and they have been bankrupt or been found guilty of an offence involving dishonesty, unless they have recorded this in the enduring representation agreement, or (d) they are the Public Representative. (2) A person may only appoint the NSW Trustee as an enduring representative in relation to financial decision-making functions. (3) The appointment does not lapse if an enduring representative (or their spouse, child, brother or sister) is subsequently engaged to provide for fee or reward healthcare, accommodation or other support services to the represented person. 

8.4 Making an enduring representation agreement 

The new Act should provide: (1) that an enduring representation agreement must be in a prescribed form and be signed by the person making the appointment and the proposed enduring representative accepting the appointment (although not necessarily at the same time or in the presence of each other) (2) for an eligible signer, where required, to sign for the person in the person’s presence and at their direction, and (3) for eligible witnesses to witness the signatures and certify that: (a) they explained the effect of the document to the person making the agreement before it was signed, and (b) the person making the agreement signed voluntarily and appeared to have decision-making ability in relation to the agreement.   

8.5 Appointment of multiple and reserve enduring representatives 

(1) The new Act should: (a) allow a person to appoint two or more enduring representatives to act jointly or severally, in relation to one or more functions, and (b) provide for situations where one or more enduring representatives cannot act (by reason of death, resignation, or loss of decision-making ability). (2) The new Act should allow a person to appoint one or more reserve enduring representatives to act if an original enduring representative dies, resigns or does not have the decision-making ability (temporarily or permanently) to act under the agreement. 

8.6 Functions of enduring representatives 

The new Act should provide that: (1) An enduring representative’s decision-making functions (and any limits or lawful conditions on them) are determined by the enduring representation agreement. (2) An enduring representative may sign and do all such things as are necessary to give effect to any decision-making function. (3) An enduring representative can access, collect or obtain personal information (including financial information and health records) about a person that that person would be entitled to access and that is relevant to and necessary for carrying out their functions. (4) The following functions cannot be given under an enduring representation agreement: making or revoking a will, making or revoking an enduring representation agreement, voting in elections, consenting to marriage, divorce, surrogacy arrangements or sexual relations, making decisions regarding the care and wellbeing or adoption of children, and managing the represented person’s property after their death. 

8.7 Responsibilities of enduring representatives 

The new Act should provide: (1) Enduring representatives must: (a) observe the Act’s general principles (b) act honestly, diligently and in good faith and not coerce, intimidate or unduly influence the represented person (c) act within the conditions or limitations of the agreement (d) ensure that they identify and respond to situations where their interests conflict with those of the represented person, ensure the represented person’s interests are always the paramount consideration, and seek external advice where necessary (e) communicate with the represented person when making decisions on their behalf and explain the decisions as far as possible (f) treat the represented person and important people in their life with dignity and respect (g) if they have a financial decision-making function: (i) keep accurate records and accounts (ii) keep their money and property separate from the represented person’s money and property, and (iii) not gain a benefit from being a representative unless expressly authorised (h) respect the represented person’s privacy and confidentiality by: (i) only collecting personal information to the extent necessary for carrying out the enduring representative’s role, and (ii) only disclosing such information when permitted by Recommendation 14.3. (2) Enduring representatives are expected, where possible, to: (a) develop a person’s decision-making skills (b) promote and maximise a person’s autonomy, and (c) provide decision-making support. (3) Enduring representatives, other than the NSW Trustee, must sign an acknowledgement that they have read and understood these responsibilities. 

8.8 When an enduring representation agreement has effect 

(1) The new Act should allow a person to specify a time from which, a circumstance in which, or an occasion on which the decision-making functions for all matters or the decision-making functions for a specified matter are exercisable. (2) If the person does not specify when the representation agreement comes into effect: (a) for financial matters, the agreement shall come into effect at the time the appointment is made (b) for personal, health and restrictive-practices decisions, the agreement shall come into effect when the represented person does not have decision-making ability for that decision. (3) A representative may exercise decision-making functions during any period when the represented person does not have decision-making ability, even if the specified time, circumstances or occasion has not arisen. 

8.9 Tribunal may declare appointment has effect 

The new Act should provide that the Tribunal may, on application by a person appointed as an enduring representative, declare that the appointment has effect if it is satisfied that: (a) the represented person does not have decision-making ability for a decision covered +by the enduring representation agreement, and (b) the appointment is valid.   

8.10 Tribunal review of enduring representation agreements 

The new Act should provide: (1) The Tribunal may review an enduring representation agreement on its own motion. (2) The Tribunal must review an enduring representation agreement if requested to do so by: (a) the represented person (b) a person with a proper interest in the proceedings (c) a person with a genuine interest in the personal and social wellbeing of the represented person, or (d) the enduring representative unless the request does not disclose grounds that warrant a review. (3) The Tribunal must, before carrying out a review, notify each party of the date, time and place of the review (although failure to do so will not invalidate any decision). (4) The Tribunal may order that the agreement is suspended until the review is complete. 

8.11 Tribunal action on review 

The new Act should provide: (1) The Tribunal, when reviewing the agreement, should consider, where relevant: (a) whether the represented person met the eligibility criteria for entering into the agreement, and (b) if the represented person did meet the eligibility criteria to enter into the agreement: (i) the fact that the representative was chosen by the person (ii) whether the eligibility criteria for a representative are still being met, and (iii) whether the representative is meeting their responsibilities and carrying out their required functions. (2) The Tribunal may, on reviewing an enduring representation agreement, confirm it, vary it (including appointing a replacement enduring representative who is eligible and suitable), suspend it or revoke it, in whole or in part. (3) Where there is doubt about the validity of an appointment, the Tribunal may confirm the appointment if the Tribunal is satisfied it was the appointment the person intended to make. (4) The Tribunal may make a representation order or support order in accordance with the new Act to supersede an enduring representation agreement that has been suspended or revoked, in whole or in part. 

8.12 Supreme Court review of an enduring representation agreement 

The new Act should provide that the Supreme Court may review the appointment (or purported appointment) of an enduring representative under an enduring representation agreement and may make such orders as it thinks appropriate. 

8.13 Supreme Court may confirm any function of an enduring representative 

The new Act should provide that the Supreme Court may, on application by a person appointed as an enduring representative, confirm (in whole or in part) any function under the enduring representation agreement if: (a) it appears that the represented person does not have decision-making ability to confirm the function, and (b) confirming the function is in accordance with the represented person’s will and preferences. 

8.14 Resignation of an enduring representative 

The new Act should provide that an enduring representative may resign their appointment: (a) if the represented person understands the nature and consequences of the resignation — by giving notice in writing to the represented person. (b) if the represented person does not understand the nature and consequences of the resignation — with the approval of the Tribunal. 

8.15 End or suspension of an enduring representation agreement 

The new Act should provide that: (1) A represented person may, by a prescribed form that is signed and witnessed, revoke an appointment under an enduring representation agreement if the represented person: (a) has decision-making ability in relation to the agreement and its revocation, and (b) revokes the agreement voluntarily. (2) An enduring representation agreement lapses if an enduring representative dies, unless there is a joint or reserve representative to carry out the functions. (3) An enduring representation agreement is suspended, so far as it appoints an enduring representative, when the enduring representative does not have the decision-making ability to act under the agreement. (4) An enduring representation agreement is suspended, in so far as it appoints an enduring representative with a financial function, if the enduring representative becomes bankrupt or is found guilty of an offence involving dishonesty. 

8.16 Possession or control of a represented person’s property 

The new Act should provide that: (1) Nothing in the new Act operates to change the ownership of any part of a represented person’s property. (2) An enduring representative, upon ceasing to act as such, must ensure that possession or control of any part of a represented person’s property in relation to which they have functions, is transferred, as the case may require, to: (a) the formerly represented person, or (b) any replacement representative who has functions in relation to that part of the represented person’s property. 

8.17 Status of an advance care directive in an agreement that has ended 

The new Act should provide that an advance care directive made in compliance with NSW law is valid notwithstanding that it is contained in an enduring representation agreement that has been suspended or revoked (unless revoked by the person making the appointment at a time when they have decision-making ability) or has lapsed. 

8.18 Effect of marriage on an enduring representation agreement 

The new Act should not provide that the marriage of a person who has made an enduring representation agreement automatically revokes the agreement. 

9. Representation orders 

9.1 Types of decisions a representation order may cover 

The new Act should provide that a representation order may apply to decisions about personal matters, financial matters, healthcare and/or restrictive practices. The order should specify what decisions or types of decisions the representative may make as well as any conditions or limitations. 

9.2 Application for a representation order 

The new Act should provide that: (1) The following people may apply to the Tribunal for a representation order: (a) the person to whom the order will apply (b) the Public Representative, Public Advocate, and NSW Trustee, and (c) a person with a genuine interest in the personal and social wellbeing of the person the subject of the application. (2) An application must specify the grounds upon which there is a need for an order. (3) The Tribunal may treat an application for a support order, or review of a support order, support agreement or enduring representation agreement as an application for a representation order. 

9.3 Grounds for an order 

The new Act should provide that: (1) The Tribunal may, after conducting a hearing into an application, appoint a person to be a representative under a representation order if: (a) the proposed represented person is at least 17 years old (b) the proposed represented person does not have decision-making ability for one or more decisions (c) less intrusive and restrictive measures are neither available nor suitable, and (d) there is a need for an order. (2) In considering whether there is a need for an order, the Tribunal should take into account, where relevant: (a) the adequacy of existing or available formal or informal arrangements in meeting the person’s decision-making needs, and (b) the availability and suitability of less restrictive and intrusive measures to meet the person’s needs, including but not limited to a support order or support agreement. 

9.4 Additional Tribunal considerations for orders in respect of Aboriginal people and Torres Strait Islanders 

The new Act should provide that, to the extent that it is appropriate and practicable to do so, the Tribunal must, when determining whether a representation order should be made for an Aboriginal person or Torres Strait Islander, have regard to: (a) the likely impact of the order on the person’s culture, values, beliefs (including religious beliefs) and linguistic environment (b) the likely impact of the order on the person’s standing or reputation in their Indigenous community, and (c) any other relevant consideration pertaining to the person’s culture. 

9.5 Eligibility for appointment as a representative 

The new Act should provide that: (1) The Tribunal can appoint, as a representative, under a representation order: (a) an eligible person, or (b) in relation to personal, healthcare and/or restrictive practices decision-making functions - the Public Representative (c) in relation to financial decision-making functions - the NSW Trustee. (2) A person is an “eligible person” if they are: (a) at least 18 years old, or (b) at least 16 years old and: (i) they are the person’s primary carer, and (ii) they are already supporting the person or making decisions on their behalf, and (iii) the proposed functions are consistent with their decision-making abilities. (3) The Tribunal (other than in an emergency representation order) must not appoint the Public Representative or the NSW Trustee as a representative if some other person can be appointed.   

9.6 Suitability for appointment as a representative 

The new Act should provide that: (1) The Tribunal may only appoint a person as a representative if it is satisfied that they are suitable and the proposed representative consents to the appointment. (2) In deciding whether a person (other than the Public Representative or NSW Trustee) is suitable, the Tribunal must take into account: (a) the will and preferences of the person in need of decision-making assistance (“the person”) (b) the nature of the relationship between the proposed representative and the person (c) the abilities and availability of the proposed representative (d) whether the proposed representative is likely to act honestly, diligently and in good faith (e) whether the proposed representative has or may have a conflict of interest in relation to any of the decisions referred to in the order, and will be aware of and respond appropriately to any conflicts (f) whether the proposed representative will promote the person’s personal and social wellbeing (g) the person’s cultural identity (h) whether the proposed representative has been convicted of a serious indictable offence, and (i) where they will have a financial function, whether the proposed representative has been bankrupt or been convicted of a dishonesty offence. 

9.7 Remuneration of professional representatives with financial functions 

The new Act should provide that: (1) The Tribunal may determine that a representative with financial functions, who carries on a business that includes the administration of estates, is entitled to remuneration out of the represented person’s estate for their work in administering that estate. (2) As part of any oversight and direction of representatives with financial functions, the NSW Trustee should decide the amount of any remuneration. 

9.8 When a representation order has effect 

The new Act should provide that: (1) A representation order has effect only if the represented person is aged 18 years or over. (2) Unless a representation order is revoked or suspended or has lapsed, it has effect in relation to a decision to which the order applies only when the represented person does not have decision-making ability for that decision. (3) The Tribunal must specify that an order (except for an emergency order) has effect for no more than: (a) 1 year for an initial order, or (b) 3 years for an order that is renewed following review. (4) However, if the Tribunal is satisfied that the represented person will never have the relevant decision-making ability and there is a need for an order of longer duration the Tribunal may specify that the order (except for an emergency order) has effect for no more than: (a) 3 years for an initial order, and (b) 5 years for an order that is renewed following review. (5) The Tribunal may specify that an order will not be reviewed at the end of the period for which it has effect, but only if the Tribunal is satisfied that, in all the circumstances, not reviewing the order promotes the personal and social wellbeing of the represented person. 

9.9 Emergency orders 

The new Act should provide: (1) The Tribunal may, where it considers it appropriate by reason of unacceptable risk to the person and urgency, (a) make an order it considers appropriate in the circumstances in respect of a person that remains in effect for a specified period of no more than 30 days, if it addresses the unacceptable risk to the person, and (b) renew the order for a further specified period of not more than 30 days if it addresses the unacceptable risk to the person. (2) The Tribunal may make the order at the request of the person to whom the order relates, or at the request of a person with a genuine interest in the personal and social wellbeing of the person to whom the order relates. (3) In making an emergency order, the Tribunal may appoint the Public Representative (in relation to personal, healthcare and/or restrictive practices decisions) and/or the NSW Trustee (in relation to financial decisions) as representative if the person does not have a representative or person responsible, and it considers that there may be grounds for making an order. (4) The Tribunal is not prevented from making an emergency order just because evidence about a person’s decision-making ability is limited. (5) In making an emergency order, the Tribunal must specify the extent (if any) to which the proposed representative has custody of the person. (6) The Tribunal cannot make an emergency order if: (a) there is a valid advance care directive that expressly prohibits the decision for which the order is sought, or (b) another order would be more appropriate. 

9.10 Multiple representatives 

The new Act should: (a) allow the Tribunal to appoint two or more representatives to act jointly or severally, in relation to one or more functions (b) provide for situations where one or more representatives cannot act (by reason of death, resignation, or loss of decision-making ability), and (c) ensure that the Public Representative and NSW Trustee are not appointed as joint representatives for the same decision-making functions with each other or with anyone else. 

9.11 Reserve representatives 

The new Act should allow the Tribunal to appoint a reserve representative to act if an original representative dies, resigns or does not have the decision-making ability (temporarily or permanently) to act under the order. 

9.12 Functions of representatives 

The new Act should provide: (1) A representative’s decision-making functions (and any limits or conditions on them) are determined by the representation order. (2) A representative may sign and do all such things as are necessary to give effect to any decision-making function. (3) A representative can access, collect or obtain personal information (including financial information and health records) about a person that that person would be entitled to access and that is relevant to and necessary for carrying out their functions. 

9.13 Responsibilities of representatives 

The new Act should provide that: (1) Representatives must: (a) observe the Act’s general principles (b) act honestly, diligently and in good faith and not coerce, intimidate or unduly influence the represented person (c) act within any conditions and limitations of the order (d) ensure that they identify and respond to situations where their interests conflict with those of the represented person, ensure the represented person’s interests are always the paramount consideration, and seek external advice where necessary (e) communicate with the represented person when making decisions on their behalf and explain the decisions as far as possible (f) treat the represented person and important people in their life with dignity and respect (g) if they have a financial decision-making function: (i) keep accurate records and accounts (ii) keep their money and property separate from the represented person’s money and property, and (iii) not gain a benefit from being a representative unless expressly authorised (h) respect the represented person’s privacy and confidentiality by: (i) only collecting personal information to the extent necessary for carrying out the representative’s role, and (ii) only disclosing such information when permitted by Recommendation 14.3. (2) Representatives are expected, where possible, to: (a) develop a person’s decision-making skills (b) promote and maximise a person’s autonomy, and (c) provide decision-making support. (3) Representatives, other than the NSW Trustee or the Public Representative, must sign an acknowledgement that they have read and understood these responsibilities. 

9.14 Effect of order on other appointments or agreements 

The new Act should provide that a representation order (including an order of the Supreme Court to like effect) suspends any enduring representation agreement, support agreement, or support order in its entirety, unless the Court or Tribunal order expressly allows a limited continuing operation. 

9.15 Orders to be forwarded to Public Representative and/or NSW Trustee 

The new Act should provide that if the Tribunal makes a representation order appointing a person other than: (a) the Public Representative as a representative in relation to a personal, healthcare or restrictive practices decision-making function, and/or (b) the NSW Trustee as a representative in relation to a financial decision-making function, it should forward a copy to the Public Representative and/or the NSW Trustee as the case may require. 

9.16 Tribunal review of representation orders 

The new Act should provide that: (1) The Tribunal may review a representation order on its own motion. (2) The Tribunal must review a representation order: (a) at the end of the period for which the order has effect (unless the order provides there is to be no review at the end of the period), or (b) if requested to do so by: (i) the represented person (ii) a person with a proper interest in the proceedings (iii) a person with genuine interest in the personal and social wellbeing of the represented person (iv) the representative, or (v) the Public Representative, the NSW Trustee or the Public Advocate, unless the request does not disclose grounds that warrant a review order. (3) The Tribunal should, before carrying out the review, notify each party of the date, time and place of the review (although failure to do so will not invalidate any decision). 

9.17 Tribunal action on review The new Act should provide that: (1) The Tribunal should, when reviewing an order, consider, where relevant: (a) whether there is still a need for the order (b) whether eligibility and suitability criteria for a representative are still met, and (c) whether the representative is meeting their responsibilities and carrying out their required functions. (2) The Tribunal may, on reviewing a representation order: (a) at the end of the period for which the order has effect, renew it, renew and vary it, or decide that it may lapse (b) confirm, vary, suspend (in whole or in part) or revoke the order, or (c) make a support order in accordance with the new Act. 

9.18 Administrative review of decisions of the Public Representative and NSW Trustee 

The new Act should provide that: (1) A person may apply to the Civil and Administrative Tribunal under the Administrative Decisions Review Act 1997 (NSW) for an administrative review of a decision of the Public Representative or the NSW Trustee that: (a) is made in connection with the exercise of the Public Representative’s or NSW Trustee’s functions as a representative under the new Act, and (b) is of a class of decision prescribed by the regulations for the purposes of these provisions. (2) Such an application may be made by: (a) the person to whom the decision relates, (b) the spouse of the person (c) the person who has the care of the person, or (d) any other person whose interests are, in the opinion of the Civil and Administrative Tribunal, adversely affected by the decision. 

9.19 Supervising representatives with a financial function 

(1) The new Act should provide that: (a) The Tribunal may require the NSW Trustee to supervise a representative with a financial function, but only if the Tribunal considers it necessary. (b) In considering whether supervision is necessary, the Tribunal must take into account: (i) the size and complexity of the represented person’s property (ii) whether there are other measures to protect the represented person (iii) any potential conflicts of interest between the represented person and the representative, and (iv) any other relevant matters. (c) The Tribunal must always require NSW Trustee supervision when appointing a professional representative with a financial function. (d) If the order requires NSW Trustee authorisation for the representative to make financial decisions, the representative can do what is necessary to protect the property pending authorisation. (2) The NSW Trustee and Guardian Act 2009 (NSW) should provide that the NSW Trustee, when supervising a representative with a financial function, may decide the nature and timing of any financial reporting. 

9.20 Enforcing representatives’ decisions 

The new Act should provide that: (1) A Tribunal order may specify the actions that: (a) a representative (b) a specified person or a person of a specified class, or (c) a person authorised by the representative may take (including the use of force) to ensure that the represented person complies with any decision of the representative in the exercise of the representative’s functions. (2) However, the Tribunal may not make such an order unless the Tribunal is satisfied that: (a) the represented person will be exposed to an unacceptable risk of harm, including by way of neglect, abuse or exploitation, if the order is not made (b) allowing such action is the least restrictive option for ensuring the represented person is not exposed to the harm in (2)(a) (c) the actions authorised by the order are appropriate and proportionate to the circumstances, and (d) the order is for the shortest period necessary to give effect to the order. (3) The Tribunal may at any time: (a) impose conditions or give directions about exercising the actions specified in the order, or (b) revoke the order. (4) A person permitted in the order to use force may use such force as is reasonably necessary in the circumstances. (5) A person acting in accordance with such an order, in good faith, is not liable to any action, liability, claim or demand arising from the action. 

9.21 Resignation of a representative 

The new Act should provide that a representative, other than the Public Representative or the NSW Trustee, may resign with the approval of the Tribunal.   

9.22 End or suspension of a representation order 

The new Act should provide that: (1) A representation order lapses if a representative dies, unless there is a joint or reserve representative to carry out the functions. (2) The Tribunal shall, on application or its own motion, review a representation order and appoint a replacement representative, where necessary (for example, if the order has lapsed). Until the Tribunal makes an order following review: (a) the Public Representative shall act as a representative for personal, healthcare and/or restrictive practices decision-making functions, and (b) the NSW Trustee shall act as a representative for financial decision-making functions. (3) A representation order is suspended, so far as it appoints a representative, when the representative does not have the decision-making ability to act under the order. 

9.23 Possession or control of a represented person’s property 

The new Act should provide that: (1) Nothing in the Act operates to change the ownership of any part of a represented person’s property. (2) A representative, upon ceasing to act as such, must ensure that possession or control of any part of a represented person’s property in relation to which they have functions, is transferred, as the case may require, to: (a) the formerly represented person, or (b) any replacement representative who has functions in relation to that part of the represented person’s property. 

10. Healthcare 

10.1 Statutory objects 

The new Act should not have separate statutory objects for healthcare decision-making. 

10.2 Application of healthcare provisions 

The new Act should provide that its healthcare provisions apply to a patient: (a) who is of or above the age of 16 years, and (b) who does not have decision-making ability for a healthcare decision. 

10.3 Decision-making ability 

The definition of decision-making ability in Recommendation 6.1 should apply to the new Act’s healthcare provisions.   

10.4 Definition of “healthcare” 

The new Act should provide that: (1) “Healthcare” includes: (a) any care, service, procedure or treatment provided by, or under the supervision of, a registered health practitioner for the purpose of diagnosing, maintaining or treating a physical or mental condition of a person (b) in the case of healthcare in the course of a medical research procedure — the giving of placebos, and (c) any other act declared by the regulations to be healthcare. (2) “Healthcare” does not include: (a) any non-intrusive examination for diagnostic purposes (including a visual examination of the mouth, throat, nasal cavity, eyes or ears) (b) first-aid (c) administering a pharmaceutical drug for which a prescription is not required and which is normally self-administered in accordance with the manufacturer’s recommendations as to purpose and dosage level (d) mental health treatment given to a patient or affected person under the Mental Health Act 2007 (NSW) or Mental Health (Forensic Provisions) Act 1990 (NSW), or (e) anything else that the regulations declare is not healthcare for the purposes of these provisions. (3) “Registered health practitioner” means a person who practises in: (a) a health profession within the meaning of the Health Practitioner Regulation National Law (NSW), and/or (b) any other profession or practice as declared by the regulations. 

10.5 Advance care directives 

The new Act should provide: (1) A patient may consent to healthcare or a medical research procedure in a valid advance care directive. (2) Healthcare must not be given and a medical research procedure must not be undertaken if it would be against a patient’s will and preference as expressed in an advance care directive that is clear and extends to the situation at hand. (3) An advance care directive can be made in any form, including orally. (4) An advance care directive can include instructions on specific matters as well as expressions of values and preferences. (5) The provisions do not limit the common law about advance care directives. (6) A requirement to consider a person’s will and preferences includes considering any valid advance care directive (see also Recommendation 5.4). (7) A registered health practitioner must make a reasonable effort in the circumstances to find out if a patient who does not have decision-making ability has an advance care directive before treating them or seeking another person’s consent to treat them. (8) Notwithstanding an advance care directive, a registered health practitioner is not under any obligation to deliver a life-sustaining measure if to do so would be inconsistent with standard medical practice. 

10.6 Urgent healthcare 

The new Act should provide: (1) Healthcare may be provided to a patient without consent if the registered health practitioner carrying out or supervising the healthcare considers the healthcare is necessary, as a matter of urgency: (a) to save the patient’s life, or (b) to prevent serious damage to the patient’s health, or (c) except in the case of special healthcare — to prevent the patient from suffering or continuing to suffer significant pain or distress. (2) In urgent circumstances, a registered health practitioner is not required to search for an advance care directive that is not readily available. 

10.7 Definition of “special healthcare” 

The new Act should provide that “special healthcare” means: (a) any healthcare that is intended, or is reasonably likely, to render the patient permanently infertile (b) any healthcare that is not supported by a substantial number of registered health practitioners specialising in the relevant practice area, or (c) any healthcare that the regulations declare to be special healthcare. 

10.8 Tribunal consent to special healthcare 

The new Act should provide: (1) The Tribunal may consent to special healthcare for a patient if it is satisfied that it is necessary: (a) to save the patient’s life, or (b) to prevent serious damage to the patient’s emotional, psychological or physical health. (2) In the case of healthcare intended or reasonably likely to render the patient permanently infertile, the Tribunal must be satisfied that the patient will not regain decision-making ability in the foreseeable future. (3) In the case of healthcare that is not supported by a substantial number of health practitioners specialising in the relevant practice area, the Tribunal may give consent only if: (a) the treatment is the only or most appropriate way of treating the patient, and (b) it is satisfied that any relevant National Health and Medical Research Council guidelines have been or will be complied with. For matters that the Tribunal must consider before giving consent, see Recommendation 10.24. 

10.9 Consent to continuing or further special healthcare 

The new Act should provide: (1) The Tribunal may, when consenting to special healthcare, authorise the patient’s representative to consent to: (a) continuing the special healthcare, or (b) further special healthcare of a similar nature. (2) The Tribunal may only give such an authority if the representative requests it or consents to it. (3) The Tribunal may at any time: (a) impose conditions or give directions as to the exercise of such an authority, or (b) revoke such an authority. (4) If the representative has such an authority, any person may ask the representative for their consent to give the relevant special healthcare. (5) In considering a request for consent to further or continuing healthcare, a representative must give effect to the will and preferences of the patient (to be determined as set out in Recommendation 5.4). 

10.10 Definition of “major healthcare” 

(1) The new Act should provide that “major healthcare” means healthcare that the regulations declare to be major healthcare. (2) The new regulations should mirror the present regulations except that HIV testing should not be included. 

10.11 Consent to major healthcare 

The new Act should provide that the person responsible or the Tribunal may consent to major healthcare for a patient. For matters that the person responsible must consider before giving consent, see Recommendation 10.22. For matters that the Tribunal must consider before giving consent, see Recommendation 10.24. 

10.12 Definition of “minor healthcare” 

The new Act should provide that “minor healthcare” means healthcare that is not special healthcare or major healthcare. 

10.13 Consent to minor healthcare 

The new Act should provide: (1) The person responsible may consent to minor healthcare for a patient. (2) If there is no person responsible, minor healthcare may be carried out on a patient without consent provided that the registered health practitioner carrying out, or supervising the minor healthcare, certifies in writing in the patient’s clinical record that: (a) the healthcare is necessary and is in a form that will most successfully promote the patient’s health and personal and social wellbeing, and (b) the patient does not object to the healthcare. (3) The Tribunal may consent to minor health care for a patient in any case. For matters that the person responsible must consider before giving consent, see Recommendation 10.22. For matters that the Tribunal must consider before giving consent, see Recommendation 10.24. 

10.14 Consent to withdrawing or withholding life-sustaining measures 

The new Act should provide: (1) The person responsible or Tribunal may consent to withholding or withdrawing a life-sustaining measure, but only if: (a) starting or continuing the measure would be inconsistent with good medical practice, and (b) the decision gives effect to the patient’s will and preferences, as set out in Recommendation 5.4. (2) Death as a result of withdrawing or withholding life-sustaining measures is not necessarily incompatible with promoting a patient’s personal and social wellbeing. 

10.15 Patient objections to healthcare 

The new Act should provide that a patient is taken to object to healthcare: (a) if the patient indicates (by whatever means) that they do not want the healthcare, or (b) if the patient: (i) has previously indicated, in similar circumstances, that they did not then want the healthcare (including in an advance care directive that is clear and unambiguous and extends to the situation at hand), and (ii) has not subsequently indicated otherwise. 

10.16 Overriding a patient’s objection to major or minor healthcare 

The new Act should provide: (1) The Tribunal may authorise a representative (at their request or with their consent) to override the patient’s objection to major or minor healthcare if satisfied that: (a) the patient has not refused the healthcare in an advance care directive that is clear and extends to the situation at hand (b) there would be an unacceptable risk to the patient if the healthcare was not given, and (c) receiving the healthcare would promote the patient’s health and personal and social wellbeing. (2) The Tribunal may at any time: (a) impose conditions on or give directions about exercising the authority, or (b) revoke the authority. (3) The patient’s representative may exercise the authority only if satisfied that the healthcare promotes the patient’s health and personal and social wellbeing. (4) These provisions do not apply to healthcare delivered in the course of a medical research procedure. 

10.17 Effect of consent and objections 

The new Act should provide: (1) A healthcare consent has effect as if: (a) the patient had decision-making ability, as defined in Recommendation 6.1, to consent to the healthcare, and (b) the healthcare had been given with the patient’s consent. (2) A consent given by the person responsible has no effect: (a) if the person giving or supervising the healthcare knows, or ought reasonably to know, that the patient objects to the healthcare, or (b) if the healthcare is to be carried out for any purpose other than that of promoting the patient’s health and personal and social wellbeing. (3) A consent given by the patient’s representative has effect even if the patient objects when the representative is authorised by the Tribunal under Recommendation 10.16. 

10.18 Identifying the person responsible 

(1) The new Act should define the “person responsible” as follows: (a) The person responsible for a young person aged 16 or 17 is the person with parental responsibility (within the meaning of the Children and Young Persons (Care and Protection) Act 1998). (b) The person responsible for an adult is the first person in the person responsible hierarchy who: (i) has decision-making ability for the decision (ii) is reasonably available to make a decision, and (iii) has not, if asked, declined to make a decision. See Recommendation 10.19 for the person responsible hierarchy. (2) The new Act should provide for a record to be made if a person in the hierarchy declines to make a decision, or if the health practitioner decides that a person who would otherwise be the person responsible is not reasonably available or does not have decision-making ability for the decision. The regulations should make provisions about the keeping of such records. (3) The new Act should provide that disputes about who is the person responsible may be referred to the Public Advocate for mediation. 1 

0.19 The person responsible hierarchy 

The new Act should provide: (1) The person responsible hierarchy is: (a) a person who is empowered to make the relevant decision under an enduring representation agreement or representation order (b) the spouse of the person, if they have decision-making ability for the decision and the relationship is close and continuing (c) a person who has the care of the person, or (d) a close friend or relative of the person. (2) The “spouse” of an Aboriginal person or a Torres Strait Islander includes a spouse married according to customary law. 

10.20 When a person “has the care of another person” 

(1) The new Act should provide that a person may be regarded as “having the care of another person” where, for example, they, on a regular basis: (a) provide domestic services and support for another person (b) arrange such services and support for another person, or (c) provided or arranged such services and support immediately before the other person moved to a place where they receive care (such as a hospital, nursing home, group home, boarding-house or hostel), provided they are or were not paid for the services and support by the other person or from any other source (except for a carer’s pension). (2) The definition of “has care of another person” should appear in the same section or part of the new Act as the person responsible hierarchy. 

10.21 Definition of “close friend or relative” 

The new Act should provide: (1) A “close friend or relative” of another person is a friend or relative (including a member of the extended family or kin of an Aboriginal or Torres Strait Islander person according to their culture) who maintains: (a) a close personal relationship with the other person through frequent personal contact, and (b) a personal interest in the other person’s welfare provided they are not paid by the other person or from any other source (except for a carer’s pension) for, or have a financial interest in, any care services that they perform for the person. (2) The definition of “close friend or relative” should appear in the same section of the new Act as the person responsible hierarchy. 

10.22 Consent of the person responsible 

(1) The new Act should provide: (a) Any person may ask the person responsible to consent to a course of healthcare for a patient. (b) The request must explain: (i) that the patient does not have decision-making ability for the decisions that need to be made (ii) the patient’s condition that requires healthcare (iii) the courses of healthcare that are available for that condition (iv) the general nature and effect of each of those courses (v) the nature and degree of any significant risks associated with those courses, and (vi) the reasons why any particular course should be carried out. (c) In considering such a request, the person responsible must: (i) give effect to the patient’s will and preferences (to be determined as set out in Recommendation 5.4), and (ii) have regard to the matters referred to in the request. (2) The regulations should provide when a consent or request for consent must be in writing.   

10.23 Application to Tribunal for consent 

The new Act should provide: (1) Any person can apply to the Tribunal for consent for healthcare for a patient. (2) The application shall state: (a) how the patient does not have decision-making ability for the decision or decisions that need to be made (b) the patient’s condition that requires healthcare (c) the courses of healthcare that are available for that condition (d) the general nature and effect of each of those courses (e) the nature and degree of any significant risks associated with those courses, and (f) the reasons why any particular course should be carried out. (3) The Tribunal need not consider an application if it is not satisfied that the applicant has a sufficient interest in the patient’s health and personal and social wellbeing. (4) Whenever an application is made for consent to healthcare and the healthcare cannot be given without that consent, the Tribunal may: (a) order the person who is to give the healthcare not to start it, or (b) if the healthcare has already started, order the person who is carrying out the healthcare to stop it, until the Tribunal has determined the application. (5) The service arrangements set out in s 43 of the Guardianship Act 1987 (NSW) should continue to apply. 

10.24 Tribunal consent to healthcare 

The new Act should provide: (1) In considering an application for consent to healthcare, the Tribunal must have regard to the matters that must be stated in the application (as set out in Recommendation 10.23(2)). (2) After conducting a hearing, the Tribunal may consent to the healthcare if it is satisfied that it is the most appropriate form of healthcare and gives effect to the patient’s will and preferences (as set out in Recommendation 5.4). 

10.25 Liability for healthcare 

The new Act should provide that nothing in the Act relieves a person from liability in respect of giving healthcare to a patient, if they would have been liable: (a) had the patient been able to consent to the healthcare, and (b) had the healthcare been given with the patient’s consent. 

10.26 Clinical records 

The new Act should provide that the regulations may make provision about keeping records of a patient’s healthcare carried out under the Act. 

10.27 Offences 

The new Act should provide: (1) A person must not give healthcare to a patient unless: (a) consent for the healthcare has been given in accordance with the new Act, or (b) the healthcare provisions authorise the healthcare without consent, or (c) the healthcare is given in accordance with an order of the Supreme Court in the exercise of its inherent jurisdiction. (2) A registered health practitioner has a defence if they have, in good faith and without negligence, administered or not administered healthcare to a patient and believed on reasonable grounds that the requirements of the Act have been complied with. (3) A person must not take another person without decision-making ability outside Australia to obtain an unauthorised sterilisation procedure. 

11. Medical research 

11.1 Definition of “medical research procedure” 

The new Act should provide: (1) A “medical research procedure” is: (a) a procedure carried out for the purposes of medical research, including (as part of a clinical trial or otherwise): (i) administering pharmaceuticals, or (ii) using equipment or a device, or (b) anything prescribed by the regulations as a medical research procedure. (2) “Medical research procedure” does not include any of the following: (a) any non-intrusive examination including: (i) a visual examination of the mouth, throat, nasal cavity, eyes or ears, or (ii) the measurement of a person’s height, weight or vision (b) observing a person’s activities (c) administering a survey (d) collecting or using information, including: (i) personal information within the meaning of the Privacy and Personal Information Protection Act 1998 (NSW) (ii) health information within the meaning of the Health Records and Information Privacy Act 2002 (NSW), or (e) any other procedure prescribed by the regulations as not being a medical research procedure. (3) “Medical research practitioner” includes a person who practises in a health profession within the meaning of the Health Practitioner Regulation National Law (NSW). 

11.2 Approval and consent to a medical research procedure 

The new Act should provide that: (1) A person can consent to a medical research procedure in an advance care directive. (2) A medical research practitioner must not administer a medical research procedure to a participant who does not have decision-making ability for that procedure unless the relevant human research ethics committee has approved the research; and (a) the participant has consented to the medical research procedure or medical research procedures of a similar nature in a valid advance care directive (b) if there is no relevant advance care directive, the person responsible has consented to the procedure, or (c) if there is no person responsible, the Tribunal has consented to the procedure. (3) The approval of the relevant human research ethics committee will not be effective for the purposes of (2) unless the committee has satisfied itself that the consent material gives sufficient information in a clear enough form to enable the person responsible to make an informed decision about participation. (4) The person responsible or the Tribunal may consent to the medical research procedure only if they are satisfied the decision gives effect to the participant’s will and preferences (to be determined as set out in Recommendation 5.4) taking into account: (a) the likely effects and consequences of the medical research procedure, including the likely effectiveness of the procedure, and (b) whether there are any alternatives, including not administering the medical research procedure. (5) The fact that a research procedure may involve administering placebos should not necessarily prevent the person responsible or the Tribunal from being satisfied that taking part would promote the participant’s personal and social wellbeing. (6) A medical research practitioner must not administer a medical research procedure if they know that the participant has refused the particular procedure in an advance care directive. (7) An interested person can apply to the Tribunal to review the decision of the person responsible and whether it gives effect to a participant’s will and preferences or promotes their personal and social wellbeing. This may include interpreting a participant’s will and preferences as expressed in an advance care directive. 

11.3 Requirement to find advance care directives 

The new Act should provide that: (1) Before a medical research practitioner administers a medical research procedure to a participant who does not have decision-making ability, they must make reasonable efforts in the circumstances to ascertain if the participant has an advance care directive. (2) Failure to take these steps is unprofessional conduct. 

11.4 Effect of a participant’s objection 

The new Act should provide that nothing may be done to a participant in the course of a medical research procedure if the participant objects orally or by conduct. This includes an objection given in an advance care directive that is clear and extends to the situation at hand. 

11.5 Medical research involving emergency treatment 

The new Act should provide that: (1) A human research ethics committee may approve a research project that involves the administration of emergency medical treatment (involving participants who do not have decision-making ability) without prior consent in accordance with Chapter 4.4 of the National Statement on Ethical Conduct in Human Research. (2) Once approved, a medical research practitioner may carry out a medical research procedure without seeking consent from the participant or the person responsible if the procedure involves administering accepted emergency treatment. (3) “Accepted emergency treatment” means urgent treatment that aligns with standard clinical practice. (4) A medical research practitioner must not administer a medical research procedure if they are aware that the participant has refused the particular procedure or a procedure of a similar nature in an advance care directive. However, a practitioner is not required to search for an advance care directive not readily available in urgent circumstances. (5) A medical research practitioner must notify the participant or the person responsible that they have been included in a medical research project as soon as reasonably possible. The participant or the person responsible must have the opportunity to stop the procedure and withdraw from the research without compromising the person’s ability to receive any available alternative medical treatment or care. 

11.6 Records to be filed with the Public Advocate 

(1) The new Act should require: (a) medical research practitioners to file a record with the Public Advocate when a person who does not have decision-making ability is enrolled as a participant in a medical research procedure, including in relation to emergency treatment, and (b) the Public Advocate to use these records to monitor and report on medical research in NSW that involves participants who do not have decision-making ability. (2) The new Act should provide that the failure of a medical research practitioner to file the necessary records with the Public Advocate amounts to unprofessional conduct. 

11.7 Offences 

The new Act should provide: (1) It is an offence for a medical research practitioner to administer a medical research procedure to a person who does not have decision-making ability, unless: (a) a human research ethics committee has approved the procedure, and (b) consent has been obtained in accordance with the new Act. (2) A medical research practitioner has a defence if they have, in good faith and without negligence, administered or not administered healthcare to a person and believes on reasonable grounds that the Act’s requirements have been complied with. 

12. Restrictive practices 

12.1 Regulation of restrictive practices 

(1) The NSW government should closely monitor the implementation of the NDIS restrictive practices regulatory scheme with a view to considering whether to apply comparable regulation in the sectors that NSW regulates, including education and mental health. (2) The new Act should provide that the Public Advocate has the function of educating families, carers and community groups about restrictive practices and the need for their reduction and eventual elimination. (3) The NSW government should consider giving the NSW Law Reform Commission a standalone reference on the use and regulation of restrictive practices in NSW once the NDIS is rolled out and all details of the scheme are known. 

13. The Public Advocate 

13.1 New advocacy and investigative functions 

(1) The new Act should introduce new advocacy and investigative functions. (2) The new Act should provide that these functions are to be carried out by a new statutory agency known as the Public Advocate. (3) The new functions should be to: (a) mediate disputes about assisted decision-making, including between: (i) parties to a court or tribunal application (ii) enduring representatives, representatives and/or persons responsible, and (iii) formal and informal supporters (b) undertake systemic advocacy for people in need of decision-making assistance through: (i) educating the community and public agencies about the decision-making framework and the role of family and friends (ii) educating and advising families, carers and community groups about restrictive practices and the need for their reduction and eventual elimination (iii) supporting organisations that promote advocacy and undertake community education (iv) monitoring, investigating, researching, reporting, making recommendations and advising on any aspect of the system the relevant Minister refers to it, and (v) having standing in court and tribunal matters of general interest to people who need decision-making assistance (c) provide decision-making advice and assistance to people who do not have access to formal decision-making support, including: (i) seeking help for people who need decision-making assistance from government agencies (including the NDIS), institutions, welfare organisations and service providers, and negotiating on their behalf to resolve issues (ii) advising people on making applications for support and representation orders (iii) advising people on and facilitating the development of support and representation agreements, and (iv) administering and/or promoting decision-making assistance services and facilities (including its own) (d) provide information and training to supporters and representatives (e) set guidelines for supporters and representatives (f) investigate suspected abuse, neglect and exploitation on its own motion or in response to a complaint, with powers to: (i) apply to an authorised officer under the Law Enforcement (Powers and Responsibilities) Act 2002 (NSW) (“LEPRA”) for a search warrant of any premises, if the Public Advocate has reasonable grounds to believe that a person in need of decision-making assistance is at risk of abuse, neglect or exploitation on the specified premises or that the new Act is being contravened (ii) execute a search warrant issued by an authorised officer under LEPRA including by entering specified premises, inspecting those premises for evidence of abuse, neglect or exploitation and seizing any evidence relevant to abuse, neglect or exploitation of a person in need of decision-making assistance (iii) require people, departments, authorities, service providers, institutions and organisations to provide documents, answer questions, and attend compulsory conferences (iv) refer complaints or allegations of abuse and neglect to Public Advocates (or equivalent) outside NSW for investigation or other appropriate action in response to alleged victims and/or alleged abusers moving across borders (v) exchange information with the relevant bodies (including the Tribunal, the NSW Ombudsman’s office, the National Disability Insurance Agency, the NDIS Quality and Safeguarding Commissioner, and relevant non-government organisations) on matters affecting the safety of a person in need of decision-making assistance – such as information relating to allegations of abuse and neglect, and (vi) have read-only access to the police (COPS) and child protection (KiDS) databases (g) when an application for a support or representation order is before the court or Tribunal, investigate, on its own motion or by request from the court or Tribunal, whether there is a need for a support or representation order and if it is the least restrictive option being taken (h) intervene in court or Tribunal proceedings in certain cases (for example, if the Public Advocate has been closely connected with the person subject to the hearing), and (i) refer possible offences under the new Act to law enforcement and prosecuting authorities. (4) The new Act should provide that it is an offence to fail to produce documents, answer questions or attend a conference in response to a request from the Public Advocate, except where doing so would result in self-incrimination or disclosure of material that is the subject of legal professional privilege. 

13.2 The Public Representative 

In addition to incorporating the new functions proposed in Recommendation 13.1, the new Act should apply the provisions currently in part 7 (the Public Guardian) of the Guardianship Act 1987 (NSW) insofar as they are consistent with the new framework. 

14. Provisions of general application 

14.1 Directions to supporters, representatives and persons responsible 

The new Act should provide that: (1) Supporters, representatives and persons responsible can apply to the Tribunal for directions about the exercise of their functions. (2) Where a person is authorised to take a particular action by an order of the Supreme Court acting in its inherent protective jurisdiction, and a Tribunal direction might conflict with this order, the Tribunal may only give directions if the Supreme Court consents. (3) Supporters, representatives and persons responsible are not liable for any acts or omissions carried out in good faith in accordance with such a direction. (4) If the Tribunal gives a direction under this section, it should ensure a copy is forwarded to the Public Representative and/or NSW Trustee, as appropriate. 

14.2 Access to personal information 

The new Act should provide that: (1) A representative, supporter or person responsible should be entitled to access, collect or obtain personal information (including financial and health information) about a person that that person would be entitled to access and that is relevant to and necessary for carrying out their functions. (2) A person holding that information, on being satisfied that a person is entitled to access that information, must allow them to access that information. 

14.3 Non-disclosure of personal information 

The new Act should provide that it is an offence for a person, including a representative or supporter, to disclose any information obtained in connection with the administration or execution of the Act unless it is: (a) for the purpose of acting as the person’s representative or supporter, including, where relevant, to seek legal or financial advice, or counselling, advice or other treatment (b) in connection with the administration or execution of the Act (c) necessary for proceedings under the Act (d) authorised by law (e) authorised by the person to whom the information relates if they have decision-making ability to do so (f) authorised by a court or tribunal in the interests of justice, or (g) disclosed to authorities as necessary to prevent serious risk to life, health or safety or to report a suspected serious indictable offence. 

14.4 Protection from liability where an agreement or order does not have effect 

The new Act should provide that: (1) A person who: (a) purports to act as a supporter or representative under a relevant agreement or order, and (b) does so in good faith, and without knowing the agreement or order does not have effect, can rely on the agreement or order in any case.   (2) A third party who: (a) relies on a person who purports to act as a supporter or representative under a relevant agreement or order, and (b) does so in good faith, and without knowing the agreement or order does not have effect, can rely on the agreement or order in any case. 

14.5 Resolving disputes between substitute decision-makers 

The new Act should provide that, if there are 2 or more people who can make a decision under the Act and they cannot agree about one or more decisions that need to be made, after attempting to resolve the disagreement (whether informally or through mediation), a person may apply to the Tribunal for directions to resolve any such disagreement by dispute resolution processes. 

14.6 No separate provision for exercising rights under adoption laws 

The new Act should not make separate provision for people who need help exercising their rights under adoption laws. 

14.7 Provisions in part 9 of the Guardianship Act 1987 (NSW) 

The new Act should incorporate the substance of the provisions contained in part 9 of the Guardianship Act 1987 (NSW), except where to do so would contradict another recommendation, and with adjustments to ensure consistency with the new framework. 

14.8 Proof of certain matters and evidential certificates 

Provisions to the effect of s 107 and s 107A of the Guardianship Act 1987 (NSW) concerning proof of certain matters and evidential certificates should not be included in the new Act. 

14.9 No mandatory registration 

(1) The new Act should not require registration of any agreement or order. (2) The new Act should provide that: (a) an enduring representation agreement that includes financial functions may be registered as though it were a power of attorney under s 51 or s 52 of the Powers of Attorney Act 2003 (NSW) (b) it does not limit a requirement or option for registration for the purposes of any other Act. 

15. The Supreme Court 

15.1 Supreme Court’s inherent protective jurisdiction 

The new Act should state that it does not limit the Supreme Court’s inherent protective jurisdiction, including its parens patriae jurisdiction.   

15.2 Jurisdiction to make orders 

The new Act should provide: (1) The Tribunal does not have jurisdiction to make a support order or representation order where: (a) an application in respect of anything that can be the subject of the support order or representation order is before the Supreme Court, or (b) an appeal resulting from such an application is before a court. (2) Where the Supreme Court has made an order, a subsequent representation order or support order by the Tribunal in respect of the same subject matter will take effect only in accordance with an order of the Supreme Court. The original Supreme Court order then ceases to have effect with respect to that subject matter. (3) Where the Tribunal has made a representation order or support order, a subsequent order by the Supreme Court will cause the Tribunal order to have no effect to the extent that it covers the same subject matter. (4) The Supreme Court may: (a) on application by the Tribunal, or by a party in relation to any proceedings before the Tribunal, order that the proceedings before the Tribunal be transferred to the Supreme Court; (b) on its own motion, or on application, order that any proceedings before it be transferred to the Tribunal to be dealt with under the new Act. 

15.3 Review of representation agreements

The new Act should provide: (1) The Supreme Court may review part or all of an enduring representation agreement (or purported agreement), provided that an application for review of the same matter is not before the Tribunal. (2) The Tribunal may review part or all of an enduring representation agreement (or purported agreement), provided that an application for review of the same matter is not before the Supreme Court. (3) An application for review may be withdrawn with the leave of: (a) the Supreme Court (if the application was made to the Supreme Court), or (b) the Tribunal (if the application was made to the Tribunal). (4) If an application for review is made: (a) to the Supreme Court, the Supreme Court may (on its own motion or on request) refer the application to the Tribunal; (b) to the Tribunal, the Tribunal may (on its own motion or on request) refer the application to the Supreme Court. 

16. Tribunal composition and procedures 

16.1 Composition of the Assisted Decision-Making Division and Appeal Panels 

The composition of the Assisted Decision-Making Division and Appeal Panels of the NSW Civil and Administrative Tribunal should be determined by the provisions of Schedule 6 of the Civil and Administrative Tribunal Act 2013 (NSW). 

16.2 Parties to proceedings 

The new Act should: (1) retain the definition of a party to Tribunal proceedings set out under s 3F of the Guardianship Act 1987 (NSW) with amendments to reflect the new framework (including the addition of the Public Advocate as a party in all cases). (2) expressly provide that a child or young person is a party to proceedings before the Tribunal if: (i) they are the person to whom the application relates (ii) they are the primary carer of the person to whom the application relates, or (iii) they would be directly affected by any support or representation order. 

16.3 The appointment process for representatives who are parents 

Under the new Act, the appointment process for parents of people who do not have decision-making ability, where this has been the case since before the person turned 18, should be the same process as the appointment process for other representatives. 

16.4 Notice and service requirements 

The new Act should provide that: (1) As soon as practicable after making a Tribunal application, the applicant must serve a copy of the application on each of the parties. (2) Before conducting a hearing into the application, the Tribunal must notify each party of the date, time and place of the hearing. (3) Failing to serve a copy of the application or a notice does not invalidate the Tribunal’s decision on the application. (4) The Tribunal should consider whether it needs to change its procedures to ensure that its registry staff: (a) take reasonable efforts to determine and notify people with a genuine interest in the person who is the subject of a hearing (b) have regard to any family violence considerations evident on the face of the available materials when deciding whether to notify family members, and (c) advise all people notified of a hearing of the outcome of the hearing. 

16.5 Representation of parties 

The new Act should provide: (1) A legal representative of the person who is the subject of an application before the Tribunal may appear without seeking leave. (2) Separate representatives must act according to the general principles set out in Recommendation 5.2. 16.6 Requirement to give evidence under oath or on affirmation The Tribunal should consider whether it needs to change its procedures to ensure parties to a Tribunal hearing give their evidence under oath or on affirmation where the Tribunal considers that there are material facts in dispute. 

17. Powers of entry, search and removal 

17.1 Powers of entry, search and removal 

The new Act should provide: (1) If the Tribunal is satisfied, on application or its own motion, that a person in need of, or receiving, decision-making assistance under the new Act, is at immediate risk of unacceptable harm (that can be mitigated by removal from premises), the Tribunal may order that an employee of the Public Advocate or a police officer enter and search premises and remove the person from those premises, using such force as is reasonably necessary in the circumstances. (2) A police officer or medical practitioner, or both, may accompany an employee of the Public Advocate executing a search and may take all reasonable steps to assist the employee. (3) When a person is removed from premises, the Public Advocate must, if necessary, assist them to find alternative accommodation and may, if necessary, apply to the Tribunal for a support order or representation order. 

18. Interaction with mental health legislation 

18.1 Interaction with the Mental Health Act 

The new Act should provide: (1) An order or agreement for support or representation may be made in respect of a patient or affected person within the meaning of the Mental Health Act 2007 (NSW). (2) An order or agreement for support or representation made under the new Act is not suspended or revoked if the supported or represented person becomes subject to the Mental Health Act 2007 (NSW). (3) If a supported or represented person is, or becomes, subject to orders under the Mental Health Act 2007 (NSW), any order or agreement for support or representation made under the new Act is only effective to the extent it does not conflict with orders made under the Mental Health Act 2007 (NSW). 

18.2 Interaction with the Mental Health (Forensic Provisions) Act 

The new Act should provide: (1) An order or agreement for support or representation may be made in respect of a forensic patient or a correctional patient within the meaning of the Mental Health (Forensic Provisions) Act 1990 (NSW). (2) An order or agreement for support or representation made under the new Act is not suspended or revoked if the supported or represented person becomes subject to the Mental Health (Forensic Provisions) Act 1990 (NSW). (3) If a supported or represented person is, or becomes, subject to orders under the Mental Health (Forensic Provisions) Act 1990 (NSW), any order or agreement for support or representation made under the new Act is only effective to the extent it does not conflict with orders made under the Mental Health (Forensic Provisions) Act 1990 (NSW). 

18.3 Decision-making for “mental health treatment” 

(1) The new Act should provide: (a) An authorised medical officer (as defined in the Mental Health Act 2007 (NSW)) may give, or authorise: (i) any mental health treatment which they consider appropriate, to a supported or represented person who is detained in a mental health facility (as defined in the Mental Health Act 2007 (NSW)) (ii) any healthcare that is incidental to mental health treatment. (b) “Mental health treatment” is a course of action taken to: (i) remedy a mental illness (ii) diagnose a mental illness (iii) alleviate or manage the symptoms or reduce the effects of the illness (iv) reduce the risks posed by or to the person with the mental illness, or (v) monitor and evaluate a person’s mental health. (c) “Mental illness” refers to a mental illness or mental disorder as defined in the Mental Health Act 2007 (NSW) or a mental condition as defined in the Mental Health (Forensic Provisions) Act 1990 (NSW). (d) Any decisions relating to healthcare other than mental health treatment for supported or represented people are subject to the new Act. (2) The Mental Health Act 2007 (NSW) should be amended to include an identical definition for “mental health treatment”. 

18.4 Consent for special healthcare 

(1) The provisions in the new Act relating to special healthcare should apply universally, including to people subject to the Mental Health Act 2007 (NSW). (2) The Mental Health Act 2007 (NSW) should refer to the new Act for matters relating to special healthcare and all provisions relating to “special medical treatment” in the Mental Health Act 2007 (NSW) should be repealed. (3) The Mental Health Act 2007 (NSW) should continue to regulate Electro-Convulsive Treatment. 

18.5 Voluntary patients 

Sections 7 and 8 of the Mental Health Act 2007 (NSW) should be amended to provide that, in cases where a representative has relevant healthcare and/or personal functions: (1) a represented person may be admitted to a mental health facility as a voluntary patient if their representative makes a request to an authorised medical officer and the represented person does not object to this request being made (2) a represented person must not be admitted as a voluntary patient if they, or their representative, objects to the admission to the authorised medical officer (3) an authorised medical officer must discharge a represented person who has been admitted as a voluntary patient if the represented person requests to be discharged, and (4) an authorised medical officer must give notice of the discharge of a voluntary patient who is a represented person to the person’s representative. 

18.6 Financial arrangements for involuntary patients 

(1) The provisions of the NSW Trustee and Guardian Act 2009 (NSW) that relate to Mental Health Review Tribunal orders for management of estates of mental health patients (s 43-51 and 88) should be repealed to remove the Mental Health Review Tribunal’s jurisdiction over a detained patient’s financial matters. (2) The new Act should provide that the Assisted Decision-Making Division of the NSW Civil and Administrative Tribunal has the power to revoke any orders relating to financial management that were made by the Mental Health Review Tribunal pursuant to the NSW Trustee and Guardian Act 2009 (NSW) or by a magistrate conducting a mental health inquiry. 

19. Recognising appointments made outside NSW 

19.1 Recognition of appointments made outside NSW 

(1) The new Act should: (a) provide for automatic recognition of valid enduring personal substitute decision-making and supported decision-making appointments made outside NSW, and (b) allow people appointed with substitute decision-making or supported decision-making functions by a court or tribunal under the law of another jurisdiction, which is listed in the regulations, to apply to the Tribunal to have their status recognised. (2) The regulations to the new Act should recognise forms of personal substitute decision-making and supported decision-making appointments and orders made outside of NSW that grant powers substantially similar to those that can be lawfully granted in NSW. 

19.2 Effect of recognition 

The new Act should provide that: (1) Recognition does not affect the validity of the original appointment in its originating jurisdiction. (2) Recognition gives the applicant the same powers as if they had been appointed in NSW. The applicant can only exercise functions authorised by their original appointment and only if those functions can be authorised in NSW. (3) Automatic recognition of a personal enduring appointment made in another jurisdiction will not bring a representative with financial functions under the supervision of the NSW Trustee. 

19.3 Tribunal review 

The new Act should provide: (1) The Tribunal has the power, after review in accordance with relevant review provisions in Recommendations 7.21(1), 7.21(2), 8.11(1), and 9.17(1), to vary, revoke, replace or confirm an order or personal appointment made in another jurisdiction as it operates in NSW. This does not affect the operation of the personal appointment or order in its originating jurisdiction. (2) The Tribunal has discretion to order that a person with a financial decision-making function under an appointment or order made in another jurisdiction be supervised by the NSW Trustee in relation to their operations in NSW. (3) Where the Tribunal varies, revokes, replaces or confirms an order as it operates in NSW, it should notify the relevant court or tribunal in the place where the original order or personal appointment was made. 19.4 Registration NSW should not introduce a compulsory register for appointments made in other jurisdictions. 

20. Transitional provisions and consequential amendments 

20.1 Review of guardianship and financial management orders made under the Guardianship Act 1987 (NSW) The new Act should provide: (1) On or after the commencement of the Assisted Decision-Making Act, the Tribunal may review a guardianship order or financial management order on its own motion. (2) On or after the commencement of the Assisted Decision-Making Act, the Tribunal must review a guardianship order or financial management order if requested to do so by: (a) the represented person (b) a person with a proper interest in the proceedings (c) a person with a genuine interest in the personal and social wellbeing of the represented person (d) the guardian or financial manager, or (e) the Public Representative, the NSW Trustee or the Public Advocate unless the request does not disclose grounds that warrant a review. (3) A guardianship order made before the commencement of the Assisted Decision-Making Act remains in force until: (a) the order reaches its review date (b) the order reaches the expiry of its term, or (c) the Tribunal reviews the order on its own motion or upon request. (4) The Tribunal must review all financial management orders made before the commencement of the Assisted Decision-Making Act that have not otherwise expired within a prescribed period. The prescribed period should be determined after consultation with the Tribunal. 

20.2 Tribunal action on review of orders 

The new Act should provide: (1) When reviewing a guardianship or financial management order made under the Guardianship Act 1987 (NSW), the Tribunal should consider where relevant: (a) whether there is still a need for the order (b) whether the eligibility and suitability criteria for a representative are met, and (c) whether the guardian or financial manager is likely to meet the responsibilities and carry out the functions of a representative under the Assisted Decision-Making Act. (2) Upon reviewing a guardianship or financial management order, the Tribunal must: (a) allow the order to lapse (b) make a representation order in the same terms as the original order or in different terms (c) revoke the order and make a support order, or (d) revoke the order. 

20.3 Review of enduring appointments 

The new Act should provide: (1) On or after the commencement of the Assisted Decision-Making Act, the Tribunal may review the appointment (or purported appointment) of an attorney under an enduring power of attorney, or an enduring guardian, on its own motion, or if requested to do so by: (a) the person making the appointment (b) a person with a proper interest in the proceedings (c) a person with a genuine interest in the personal and social wellbeing of the appointor (d) the guardian or attorney, or (e) the Public Representative, the NSW Trustee or the Public Advocate, unless the request does not disclose grounds that warrant a review. (2) The appointment of an enduring guardian or the appointment of an attorney under an enduring power of attorney, made before the commencement of the Assisted Decision-Making Act, remains in force unless the Tribunal decides it should not remain in force (in whole or in part) after such a review. 

20.4 Tribunal action on review of an enduring appointment 

The new Act should provide: (1) When reviewing the appointment or purported appointment of an enduring guardian under the Guardianship Act 1987 (NSW), or an attorney under an enduring power of attorney, the Tribunal should consider where relevant: (a) whether the appointor met the eligibility criteria for entering into the arrangement, and (b) if the appointor did not meet the eligibility criteria for entering into the arrangement: (i) the fact that the enduring guardian or attorney was chosen by the appointor (ii) whether the eligibility and suitability criteria for an enduring representative are met, and (iii) whether the enduring guardian or attorney is likely to meet the responsibilities and carry out the functions of a representative under the Assisted Decision-Making Act. (2) Upon reviewing an enduring appointment, the Tribunal may confirm it, vary it, suspend it or revoke it, in whole or in part. (3) The Tribunal may make a representation order or support order in accordance with the new Act to supersede an enduring appointment that has been suspended or revoked, in whole or in part. 

20.5 Responsibilities of past appointees 

The new Act should provide that all guardians, enduring guardians, attorneys under enduring powers of attorney and financial managers must observe the new general principles (Recommendation 5.2) from the commencement of the new Act. 

20.6 Consequential amendments to other statutes 

Amendments should be made to NSW statutes that reference guardianship law and guardianship arrangements, to ensure that the terminology and intent of those references is consistent with the new Act.