Home' Australian Pharmacist : Australian Pharmacist October 2012 Contents 758 Australian Pharmacist October 2012 I ©Pharmaceutical Society of Australia Ltd.
Informed consent versus
The issue of consent is a complex area
and I note Ms Di Costa's recent article
(Australian Pharmacist, August, 2012,
page 642.), which unfortunately contains
several concerning inaccuracies.1
In NSW the age of consent for medical
treatment is 16 years of age, not 18 years
as stated in the article. Persons aged
14 to 16 years of age may also give
consent for treatment if assessed as
having the capacity to give consent
(the 'mature minor').2
The statement that 'NO [sic] adult may
give consent on behalf of another adult
unless they hold a power of attorney'
is untrue. Power of attorney per se
does not confer the power to make
medical decisions -- it pertains only to
nancial a airs, whereas guardianship
pertains to medical/personal a airs.3,4
Substitute consent may be sought from
a 'person responsible', who is usually
the next-of-kin, a family member, close
friend, the public guardian, etc (who may
incidentally hold power-of-attorney).
The full details of substitute consent,
enduring guardianship, and the legal
situation in other Australian states, are
unfortunately well beyond the scope of
Regarding the case study, there appears
to be some confusion between 'informed
consent' and 'informed decision-making'.
It should be self-evident that consent
is not an issue in a situation where
a patient's autonomy has not been
impinged in any way. Taking (or not)
a medication supplied by a pharmacist
is a patient's autonomous decision and
therefore no consent is required -- indeed
it is di cult think of a scenario where it
would be necessary to obtain consent
in the context of medication supply.
On the other hand if a pharmacist were
to, say, administer a vaccine to a patient
it would require informed consent.
Providing adequate information to a
patient to allow him/her to make an
Letters to the Editor
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informed decision is a matter of ful lling a
pharmacist's professional duty rather than
a matter of informed consent.
Dr Kieren Po
Resident Medical Officer, Sydney Local
Health District, Clinical Associate, Sydney
Medical School, The University of Sydney.
1. Di Costa N. Patient consent: are patients making informed
decisions? Australian Pharmacist 2012;31(8):642--4.
2. New South Wales Department of Health. Consent to Medical
Treatment -- Patient Information (PD2005_406). North Sydney:
NSW Health; 2005.
3. Powers of Attorney Act 2003 (NSW).
4. Guardianship Act 1987 (NSW).
'The author thanks Dr Po for the feedback
and acknowledges the two noted errors
included in a table within the article were
an oversight in editing. She agrees that
the case study was rather about informed
decision-making however changes to
pharmacy practice do create situations
that are becoming more complex.
The case study was chosen given the
short length of the article as a means of
demonstrating concepts in a simpli ed
manner that could apply to medication
supply and hence the target audience'.
Nikki Di Costa
HMR direct referrals
Trish Russell's excellent article in last
month's Australian Pharmacist (September
2012, page 728) highlights the bene ts of
accredited pharmacists receiving direct
referral for HMRs. Since implementation
one year ago there has been much
anecdotal support from GPs for this
model. But there has also been published
evidence on the bene ts.
Edwin Tan from Monash University
presented at the National Medicines
Symposium earlier this year on their
project Pharmacists in Practice Study
(PIPS). Pharmacists provide HMRs, short
patient consultations, drug information,
education sessions and quality assurance
activities to optimise medication
outcomes for both patients and sta .
PSA 2011 Young Pharmacist of the
Year, Chris Freeman has shown through
his practice that the integration of a
pharmacist into the general practice
team is associated with an increase in
the timeliness and completion rate of
This practice pharmacist model does not
mean HMRs are conducted routinely in
the GP's surgery and it certainly does
not damage our professional integrity or
relationships with GPs and consumers.
Being part of a multidisciplinary team,
conducting HMRs as well as a role
in GP education, medication safety,
pharmacovigilence, and clinical audits
will only enhance our reputation as
patient-centred health professionals.
Integration and co-location of a practice
pharmacist into primary healthcare
providing quality services will reap
bene ts for all pharmacists. This model
relies on e ective collaboration between
the practice pharmacist and all the
patient's health providers, including
Don't let 'turf wars' hinder the progress
of this innovative model. The success of
HMRs should be measured by improved
patient outcomes, not political agendas.
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