Health Law

Contributor: Associate Professor Thomas Faunce

Currency of information: February 2009

This Chapter on Health Law draws upon material in the Victorian 2005 Law Handbook, published by the Fitzroy Legal Centre.

How can Ethics, Law and Human Rights about Health Help Me?

The professional conduct of doctors and other health professionals (such as nurses, physiotherapists, counsellors) are regulated by codes of ethics such as the updated version of the Hippocratic Oath called the Geneva Declaration and the Australian Medical Association Code of Ethics. Central to such codes are doctors' obligations to preserve a patient's secrets, not deliberately harm or abuse patients, treat patients equally and to only treat a patient within their level of competence and expertise. Their conduct concerning proposed research, considered by various Ethics Committees, must also reflect a variety of principles. Research principles flow from the Declaration of Helsinki, prohibiting, for example, conflicts of interest a doctor may have (such as undisclosed financial gain from the research) and requiring free and fully informed consent, including an understanding of any risks involved with the experiment. Also relevant are ethical statements produced by the National Health and Medical Research Council (NHMRC) (for example, on the conduct of human research and use of new reproductive technologies). Local institutional guidelines and policies include contractual terms of employment of hospital staff. Also relevant are judicial decisions ("case law"), laws of both the Federal Parliament and the ACT Legislative Assembly (legislation) and to some extent international human rights.

The first Bill of Rights in any Australian jurisdiction was the Human Rights Act 2004 (ACT). This Act acknowledges the civil and political standards extracted from the International Covenant on Civil and Political Rights. The Act, in this context, ensures that any interpretation of ACT legislation must, "as far as possible" (s 30), comply with international human rights norms in health-related areas such as the right to life (s 9), freedom from cruel, unusual or degrading treatment of punishment (s 10(1)), free consent to scientific experimentation and medical treatment (s 10(2)) and right to privacy (s 12). Furthermore, the ACT Supreme Court has the power to issue a declaration of incompatibility to the Attorney General when a law cannot be interpreted consistently with human rights obligations (s 32).

Human Rights Amendment Act 2008 (commenced 1 January 2009)

The Human Rights Amendment Act 2008 (ACT), which commenced on 1 January 2009,inserted a new s 28(2) into the Principal Act which provides:

In deciding whether a limit is reasonable, all relevant factors must be considered, including the following:

(a) the nature of the right affected;

(b) the importance of the purpose of the limitation;

(c) the nature and extent of the limitation;

(d) the relationship between the limitation and its purpose;

(e) any less restrictive means reasonably available to achieve the purpose the limitation seeks to achieve.

New s 28(2) is modelled on s 7 of the Victorian Charter of Human Rights and Responsibilities Act 2006 and s 36 of the Bill of Rights in the Constitution of the Republic of South Africa 1996. Its intention is to provide guidance in the application of the general limitation clause in s 28(1) and to reduce its uncertainty. The list of relevant factors in s 28(2) reflect what is known as the "proportionality test". The concept of proportionality as the means of determining how and when human rights may be limited is a well-accepted principle in international law and comparable human rights jurisdictions - see, for example, General Comment No 22 by the United Nations Human Rights Committee; in the context of the European Court of Human Rights, see Handyside v United Kingdom (1979); under the United Kingdom Human Rights Act 1998, see London Regional Transport v Mayor of London (2001), Brown v Stott (2001), R v A (No 2); in Canada, see R v Oakes (1986); and in New Zealand, see Noort v MOT (1992).

The Human Rights Amendment Act 2008 (ACT), with effect from 1 January 2009, also inserted new s 30 which provides: "So far as it is possible to do so consistently with its purpose, a Territory law must be interpreted in a way that is compatible with human rights."

The new s 30 clarifies the interaction between the interpretive rule and the purposive rule such that, as far as it is possible, a human rights consistent interpretation is to be taken to all provisions in Territory laws. This means that unless the law is intended to operate in a way that is inconsistent with the right in question, the interpretation that is most consistent with human rights must prevail. This is consistent with the Victorian approach contained in s 32(1) of the Charter of Human Rights and Responsibilities Act 2006 (Vic). It also draws on jurisprudence from the United Kingdom such as the case of Ghaidan v Godin-Mendoza (2004), which was recently cited by the ACT Supreme Court in Kingsley's Chicken Pty Limited v Queensland Investment Corporation and Canberra Centre Investments Pty Limited (2006).

New s 40B of the ACT Human Rights Act, with effect from 1 January 2009, provides that:

(1) It is unlawful for a public authority:

(a) to act in a way that is incompatible with a human right; or

(b) in making a decision, to fail to give proper consideration to a relevant human right.

Public authorities are defined as:

(a) the operation of detention places and correctional centres;

(b) the provision of any of the following services:

(i) gas, electricity and water supply;

(ii) emergency services;

(iii) public health services;

(iv) public education;

(v) public transport;

(vi) public housing.

Preparing to Consult a Health Professional

Before seeing a doctor or health professional you should do a web search for information about the procedure that is proposed. If you are unsure about the quality of a surgeon, for example, you can make a note to ask about their experience with the procedure, his or her own complication rates, including post-operative wound infections, and any certificates of additional training he or she has obtained. Technical competence of a proposed doctor is difficult for a patient to get reliable information about, but in public hospitals the registrars (senior trainees) work closely with many specialist surgeons and are in a good position to compare their work, provided the registrar is already treating you. Doctors have an ethical and possibly a legal obligation to permit you to obtain a second opinion. If you have a complicated medical history you should have your regular doctor prepare a summary. If you are undertaking a risky procedure, you should consider preparing an advance directive.

What Information Must a Patient be Given and Understand?

To avoid legal action for assault or battery (trespass to the person), doctors and other health professionals must obtain a patient's free consent as to the "nature" of what is proposed before they undertake any medical procedure or treatment (Chatterton v Gerson (1980)). This applies even where the proposed treatment would clearly benefit the person and a failure to treat them may result in harm that could have been avoided. The principle applies not only to treatment but also to diagnostic and investigative procedures. Convenience to either the patient or surgeon (for example not having to start the operation again another day after an unusual finding) is not an exception to this rule (Murray v McMurchy (1949)). Free consent to medical treatment and experimentation is also a human rights obligation (see Article 7 International Covenant on Civil and Political Rights and the ACT Human Rights Act (2004) s 10(2)).

Prior consent is based on the understanding that a competent adult patients inherent dignity gives them the right to make their own ("autonomous") medical decisions, even if it is apparently not in their "best interests". The law has also increasingly emphasized that adequate information must be given when making an informed decision with respect to a medical procedure. This adequate information includes accurate, up-to-date details about a patient's medical condition and prognosis; the available options for investigation or treatment and their advantages and disadvantages, including what is likely to happen if nothing is done; and the availability of more skilled or experienced doctors.

Case law dealing with the level of information necessary for an informed decision, has predominately concerned itself with the type and amount of information that needs to be given in relation to the potential risks of a procedure. The High Court in Rogers v Whitaker (1992) said that a doctor must inform a patient of the "material" risks, and that the risk is material if:

In the circumstances of the particular case, a reasonable [that is, an "ordinary"] person in the patient's position, if warned of the risk, would be likely to attach significance to it or if the medical practitioner is or should reasonably be aware that the particular patient, if warned of the risk, would be likely to attach significance to it.

Essentially, this means that a patient should be warned of risks that are:

• objectively reasonably likely; or
• of particular (subjective) concern to that person that has been communicated beforehand to the doctor.

Printed materials are the best way to give the objective risk information, further allowing adequate time for the patient to reflect upon it and discuss it with relatives and friends. A 'cosmetic' procedure requires more information than surgery that is required for the preservation of life or health and would have most likely proceeded regardless of the answer given. Serious risks, like death, stroke or paralysis should be mentioned even if they are remote. Relatively minor injuries like bruising after a doctor places a plastic cannula into a vein or damage to the front teeth on intubation by an anaesthetist may be material if they are more frequent. Unusually inquisitive patients however, may need to be given more information about the associated risks (Chappel v Hart (1998); Rosenberg v Percival (2001)).

Patients should ask for the risk information to be given to them in writing and to then be able to go home and consider it. When asked to sign a "consent form", the patient should ensure they have not been given a "pre-med" (sedative or sleeping-pill) or are in some other way not thinking clearly. If they have particular concerns they should be sure that the doctor or themselves note them on the form, as well as the doctor's answers. If language is a difficulty they should ask for an interpreter.

The doctor should mention whether he or she has any conflict of interest (for example, holding shares or a managerial position in a company marketing a product or device that will be used in the procedure). If the doctor wants to include you in a research project, that consent discussion should take place at a different time.

When May Less Information Be Given?

There are several situations in which less information may be justifiable.

The first is in an emergency. It is lawful for a doctor to treat a patient without any information or consent, if they believe that treatment is necessary to protect or sustain the patient's life or health. If, for instance, a patient is unconscious, a health professional may perform whatever procedures are reasonably necessary in the circumstances to preserve the patients life or health. It is not necessary to obtain the consent of the patient's next of kin, although that is generally done as a courtesy.

The second case in which less information may be required is when the patient waives the right to be given information. Ethically, a doctor should confirm that the reasons behind such a refusal do not involve a misunderstanding.

The third situation is a doctor's limited discretion (therapeutic privilege) not to disclose information where he or she has reasonable grounds to believe and is prepared to document that disclosure of the information may itself harm the patient (for example, if the patient is suicidal or mentally ill). Mere anxiety in the patient is not a sufficient reason under this ground for a doctor to withhold information.

Other situations where it may be possible for a doctor to treat a patient without consent is when a patient is unconscious, where the patient has previously completed a written, signed and witnessed (or non-written, witnessed) health direction under the Medical Treatment (Health Directions) Act 2006 (ACT), where a guardian has been appointed or the ACT Civil and Administrative Tribunal (ACAT) is involved under the Guardianship and Management of Property Act 1991 (ACT), or where a patient requires treatment as an involuntary patient or during a community care order under the Mental Health (Treatment and Care) Act 1994 (ACT).

Capacity to Consent

The principles that people may not be given medical treatment without their consent, and that they are entitled to adequate information to make an informed choice, apply to competent adults (that is, to people over 18 and who are able to understand their condition and the options for treatment). Different considerations apply for children and adults who have an intellectual disability or suffer from severe mental illness.

Children

If the person is a child (under 18), either parent or a guardian may generally consent to a medical procedure. The parent or guardian is also entitled to the same information as an adult patient. However, an older child may also be able to consent if they are sufficiently mature so as to understand the nature and risks of a procedure. This will depend on the child's age, level of maturity, as well as the particular procedure. Even relatively young children can consent to simple procedures for their own good, such as a vaccination. On the other hand, greater maturity and understanding will be required for procedures that are risky or contentious, such as contraception (Gillick's Case (1986) AC 112). A child between 14 and 16 years of age may visit a doctor without their parents or guardian knowing, but this must be made clear to the doctor. In the cases of abortion, reproductive sterilisation, or medical procedures concerned with contraception, and of a mentally handicapped minor, the parent or appointed guardian alone cannot consent, the ACAT must be involved and possibly a court (Guardianship and Management of Property Act 1991 (ACT) s 7(B) and Marion's Case (1992) 175 CLR 218).

Intellectually disabled adults

People who have an intellectual disability or mental illness may not be able to consent to medical treatment. Again, this will depend on the patient's level of understanding (which may fluctuate) and the nature of the procedure. If the impairment is slow to develop, persons may make an enduring power of attorney allowing a nominated person to give consent to lawful medical treatment on their behalf, donating a body part, blood or tissue and to the withholding or withdrawal of medical treatment (Powers of Attorney Act 2006 (ACT)).

If a person has impaired decision-making capacity due to a permanent or long-term disability, and is over 18, consent may be given by a person appointed as a guardian by the ACT Civil and Administrative Tribunal. However, the Tribunal itself is required to consent to the following "prescribed medical procedures" in persons with impaired decision making ability: abortion, reproductive sterilisation, hysterectomy, medical procedures concerned with sterilisation, removal of non-regenerative tissue (a transplantation to the body of another living person), treatment for psychiatric illness, and convulsive therapy (ss 69-70 Guardianship and Management of Property Act 1991 (ACT)).

In exercising the guardian's powers under an enduring power of attorney, a guardian must act, so far as possible, in the manner that the incapacitated person would have acted if they were not incapacitated.

Access to Medical Records and Confidentiality

Medical Records Legislation

Patients who have been treated in public hospitals do not have an automatic right at common law to their medical records (Breen v Williams (1996)). This means they cannot legally grab the notes from a doctor or the chart trolley and read them. Instead, they may apply for access to their medical records under s 12 of the Health Records (Privacy and Access) Act 1997 (ACT). After a request is made the notes must be provided within 14 days, after ensuring that such disclosure would not create a reasonable risk to the life or health of the patient or to some third party, or disclose information given in confidence (ss 13-17). Commonwealth privacy legislation is also relevant in this context.

In the case of an emergency, and a patent is unable to consent to the disclosure of medical records, the doctor may discuss personal medical information with an immediate family member if it is reasonable and necessary for the proper treatment of that patent.

If you have a complaint in relation to access or improper disclosure of medical records you can lodge a complaint with the ACT Health Services Commissioner.

Confidentiality in the Doctor-Patient Relationship

Having explained the law, it should be noted that confidentiality in a hospital setting is a fluid concept. There may be tens of people who have access to information contained in a patient's file, all of whom will have valid reasons for requiring that access. They may include doctors, nurses, other treating practitioners, and administrative staff.

In addition to the statutory offences of breaching confidentiality, doctors and other health service providers may be sued at common law if they divulge confidential information without a patient's permission. The patient may sue for breach of contract or because the doctor has been negligent in disclosing the information. The patient may then be awarded compensation for loss suffered as a result of the wrongful disclosure.

However, it is lawful for a health professional to disclose information if:

• some other law requires disclosure; or
• it can be argued that the person has provided express or implied consent for the disclosure; or
• it may be in the public interest for the information to be disclosed.

Some other laws may require disclosure of otherwise confidential information, including:

• revealing the blood alcohol level of a car driver after a motor accident;
• reporting of information under the Births, Deaths and Marriages Registration Act 1997 (ACT);
• reporting unusual deaths to the Coroner;
• reporting cases of suspected child sexual abuse or non-accidental physical injury by doctors, dentists, nurses, midwives, child care workers and school teachers (s 356 Children and Young People Act 2008 (ACT)); and
• notifying infectious diseases.

Situations where consent to a breach of confidentiality may be implied include accident compensation claims where the employer may be given information about the nature of the employee's treatment, and reports provided for the purpose of insurance.

The Firearms Act 1996 (ACT) (s 115(1)) allows (but doesn't mandate) a doctor to breach confidentiality where they believe a person will pose a threat to themselves or the community and that they have possess or have access to a firearm.

Doctors who have an HIV-infected patient may also be justified in breaching confidentiality by notifying a spouse or sexual partner of the patient who may be at risk of contracting the disease. There is an ethical and common law duty upon doctors to warn third parties, in order to prevent an immediate risk of serious harm occurring to them through the conduct of a patient.

Beginning of Life Issues

Abortion

Abortion is no longer a crime in the ACT if performed by a registered medical practitioner, in a medical facility approved in writing by the Minister (ss 80-83 of the Health Act 1993 (ACT)). A doctor or nurse is under no legal duty to carry out or assist in an abortion (s 84). Pregnant women considering an abortion are no longer required by law in the ACT to view images of the foetus (Health Regulation (Maternal Health Information) Repeal Act 2002 (ACT). In ethical and legal terms, the interests of the pregnant woman are stronger prior to viability (capacity for the foetus to exist independently outside the womb) and the State's interests stronger afterwards. The right to life in the Human Rights Act 2004 (ACT) only applies from birth.

A person 16 years or older may have an abortion without the consent of a legal guardian. A referral is not required in the ACT when seeking the termination of a pregnancy. Marie Stopes International carry out termination procedures in the ACT. They can be contacted on 1800 003 707 (National 24 hour service). Sexual Health and Family Planning ACT (ph.(02) 6247 3077) can also be contacted in relation to unplanned pregnancy counselling. Capital Gynaecology, based in Queanbeyan, offers similar services (ph.(02) 6299 5559). See further Contacts and Links.

Artificial Reproductive Technology

Artificial reproductive technology (ART) centres in the ACT currently rely on ethical guidelines published by the NHMRC ( Ethical guidelines on the use of assisted reproductive technology in clinical practice and research) for their chief guidance. The Parentage Act 2004 (ACT)establishes that, where semen donation is used to produce a pregnancy, the husband of the pregnant woman is presumed to be the father (s 11). Where a pregnancy has arisen from ovum donation, the woman who underwent the ART procedure is presumed to be the mother (s 11).

Under the Parentage Act 2004, it is an offence for someone to enter into a commercial agreement for a substituted pregnancy (s 41), or to procure someone or advertise for someone to enter into a substituted pregnancy agreement (ss 42 - 43). It must also be noted that ART clinics must be accredited by the Reproductive Technology Accreditation Committee of the Fertility Society following their Code of Practice (revised in 2005), and must comply with the NHMRC Ethical Guidelines (above) which were revised in 2007.

The Canberra Fertility Centre and Sydney IVF operate in the ART area in Canberra but no longer from the John James Private Hospital. Research tends to confirm that in vitro fertilisation (IVF), that is impregnation of an ovum with sperm outside the body prior to re-implantation, drops off markedly as a successful technique for pregnancy in females over 35 years, to minimal rates in those over 40 years. IVF is expensive (though subject to a Medicare rebate) and the woman may be exposed to side effects such as ovarian hyperstimulation syndrome.

Excess ART Embryo Research and Genetic Testing, the "Right Not-To-Know"

One controversial area in ART involves pre-implantation genetic testing for sex selection. An ACT policy discussion paper has been produced in this area. Some argue that the embryo is not a legal entity or that parents should have the right to determine the gender mix in their family, especially in a situation where some selection is taking place anyway (the embryo growing most vigorously is implanted). Others believe that discarding embryos for such a reason (rather than the presence of a sex-linked genetic disease) instrumentalises them ethically (makes them valuable only for another's use, not according to their own intrinsic dignity). Another controversial area ethically concerns whether anonymous sperm donation should be used when children so conceived may subsequently have health and personal reasons for trying to locate their genetic father. Debate also arises about parents seeking to test a child for a genetic disease (for example, onset in middle-age Huntington's disease) that they do not wish to be tested for themselves. Such testing might deprive the child of their human right not to know their genetic predisposition to disease. All babies in Australia are subjected to a heel-prick test for certain inherited diseases that are easily treated. The status of the blood so taken and stored is controversial, as in the future it may provide a vast amount of information about the individual to the State.

Another topical debate involves research involving excess ART embryos. National uniform legislation has been implemented to ban human cloning and other unacceptable practices involving excess ART embryos. The NHMRC assesses applications for licenses to use human excess ART embryos for research under the Prohibition of Human Cloning Act 2002 (Cth) and the Human Embryo Research Act 2002 (Cth). Such legislation is under review as it may have the unintended effect of inhibiting the creation of patents that would establish Australia as a world leader in this area and eventually provide relief of conditions involving organ failure and spinal cord damage.

Middle of Life Issues

Blood Donations and Transfusions

Who can donate blood?

Under the Transplantation and Anatomy Act 1978 (ACT), an adult of sound mind can donate blood (s 20). For the purposes of this Act, an adult is a person who is 16 or over or who is married. If a doctor advises that the donation of blood by a child is unlikely to be harmful to the child's health and the child agrees to the donation, a parent may give written consent to the donation on behalf of the child.

You can donate blood at the Red Cross Building near Canberra Hospital on the corner of Hindmarsh Drive and Palmer Street or can contact them on (02) 6206 6006. If you have any questions as to whether you are able to donate blood, or the impact your blood donation may have on activities you have for the following days, you can contact the Red Cross Blood Service on 13 14 95.

Blood transfusions to children

In some circumstances, it is lawful for doctors to give blood transfusions to children, even where the consent of a parent or legal guardian has not been obtained or has been refused. It must be the doctor's opinion (and that of at least one other medical practitioner) that, without the compatible transfusion, the child is in danger of dying (Transplantation and Anatomy Act 1978 (ACT) s 23).

If the child is in a hospital, the consent of the chief executive officer (CEO), medical superintendent, or emergency sub committee of the clinical ethics committee should also be obtained.

Organ Donation by Living Persons

What Sort of Human Tissue can be Donated?

The Transplantation and Anatomy Act 1978 (ACT) states that adults may donate specified "regenerative tissue" and "non-regenerative tissue" (ss 8-9). Regenerative tissue is human tissue that, after injury or removal, is replaced in the body of a living person by natural processes (for example, bone marrow). Regenerative tissue can be donated for transplantation to another person or for therapeutic, medical or scientific purposes. Non-regenerative tissue, such as a kidney, can only be donated for transplantation purposes.

Generally, only adults may donate tissue. However, a parent of a child may give written consent to the donation of regenerative tissue by the child for the purposes of the transplantation of the tissue to another member of the family of the child (ss 13-14).

Transplantation of non-regenerative tissue from the body of a child can only occur in very restricted circumstances, such as where a family member is in danger of dying, all parties understand and a specially appointed committee agrees (s 14).

This Act will be subject to change when a collective review of the Human Tissue Act in each jurisdiction is completed. In it's place will be national, uniform legislation governing human tissue donations.

If you have any questions, referrals or concerns about organ donation you can contact the Canberra Hospital on 6244 2222 (24 hours) and request the organ donation co-ordinator. You can also register your (yes/no) intentions on the Australian Organ Donor Register 1800 777 203 (Free call), visit your local Medicare office, or register online. Registrations received from people under 16 will not be recorded on the Donor Register. If a patient is 16 or 17 at the time they are declared "brain dead", their intention or objection to an organ donation may be discussed with a family member at the time of death.

Public Health Legislation

Public health legislation involves a wide variety of laws designed to ensure that the public is protected from health threats such as polluted air, water, food or land, as well as infectious disease outbreaks and other hazardous behaviour (smoking, drug use, etc).

Food and water quality

The Food Act 2001 (ACT) which deals with food labelling (use by and best before dates, percentage labelling) also creates a system for its supervision. The legislation also explains the seriousness of the offences relating to the 'knowingly' unsafe handling or sale of food and well as misrepresentation. The Act ensures ACTEW-AGL's compliance with the Australian Drinking Water Guidelines and also checks on compliance with the Australian Recreational Water Guidelines. Lake Burley Griffin, however, is under Commonwealth, not ACT, jurisdiction and its water quality is monitored by the National Capital Authority. The ACT Health Protection Service has no jurisdiction over Commonwealth buildings and standards there are somewhat mysterious and difficult to ascertain or describe.

Smoking

The Tobacco Act 1927 (ACT) restricts outlets in relation to selling and advertising tobacco. Among other restrictions it limits the sale of cigarette's to people over 18 years and sets out the penalties for sale of cigarettes to a minor or purchase for a minor. The Smoke-Free Areas (Enclosed Public Places) Act 1994 (ACT) requires that public enclosed spaces apply for an exemption before smoking is permitted over a proportion of the premises usually after an upgrade of the air-conditioning system.

Recent amendments to the Tobacco Act 1927 by the Tobacco Amendment Act 2008, which had fully commenced by 28 February 2009, prohibit point of sale displays, remove the ministerial exemption for tobacco advertising and sponsorship, amend the definition of vending machine, ban rewards for smoking product purchases, ban flavoured cigarettes and split packets. The amendments were designed to further minimise tobacco use and exposure by removing displays from view and obliging licensees to store products out of view, for example under the counter or in drawers so that packets and cartons cannot be seen. The new laws exclude tobacco products from fly buys and discount petrol voucher schemes so they don't create an incentive for people to spend more on bulk smoking product purchases to gain a reward.

Asbestos

The Building Act 2004 (ACT) sets out the requirements for building and construction. This includes guidelines where work involves asbestos.

Sexually transmitted and notifiable diseases

The Minister has designated sexually transmitted diseases to include the following: Gonorrhoea, Syphilis, Chancroid, Chlaymydia disease, Genital herpes, Donovanosis (granuloma inguinale), Lymphogranuloma Venereum, SARS. These sexually transmitted diseases are listed in the Public Health Act 1997 (ACT) and the Sexually Transmitted Disease Act 1956 (ACT).

Section 5A of the Sexually Transmitted Diseases Act 1956 (ACT) obliges a doctor to notify the Chief Medical Officer if, on reasonable grounds, they believe that the patient may or has a sexually transmitted disease. Section 6(1) also requires the medical practitioner to notify the Chief Health Officer if the patient fails to have to required treatment. (See also s 100 of the Public Health Act 1997). The pathology testing laboratory is also required to notify if the following diseases are detected (ss 6A and 103 respectively): pertussis, measles, mumps, rubella, campylobacter, cholera, cryptosporidium giardia, salmonella, shigella, typhoid, food poisoning, yersiniosis, hepatitis A, B and C, barmah forest virus, leptosporidiosis, listeriosis, hydatid disease, dengue fever, legionnaire's disease, leprosy, malaria, meningococcal infection, ornithosis, Q fever, Ross River, tuberculosis and other mycobacterium. The Public Health (Infectious and Notifiable Diseases) Regulations 1983 (ACT)made AIDS (and presumably HIV) a notifiable disease in the ACT. This regulation is now repealed but an extensive list of notifiable diseases can be found in the Public Health Notifiable Conditions Determination 2005.

The Sexually Transmitted Diseases Act 1956 (ACT) authorises the ACT Chief Health Officer to require a person suspected of having an STD to submit to a medical examination, s 8 authorises apprehension by the police, and s 9 authorises a Magistrate to order attendance and compulsory detention (s 12) if necessary at a hospital. These requirements do not apply to the military (s 19).

Section 18 of the Public Health Act 1997 (ACT) allows the ACT Health Minister to make a declaration that some conduct is a "public health risk activity." Section 112 creates an obligation on members of the public to report a public health hazard. Section 108 allows authorised notification of carriers of notifiable diseases.

Section 4 of the Blood Donation (AIDS) Act 1987 (ACT) creates a defence if a person receives HIV from a transfusion if the appropriate certificate was on the container.

Prostitution

The Prostitution Act 1992 (ACT)creates liability in a brothel owner for failing to take reasonable steps to stop one of his workers spreading an STD (s 24) or using taking a medical examination as an excuse for falsely representing the worker has no STD (s 26). Prophylactics must be used in legal commercial sex in the ACT (s 27).

Tattoos

The Public Health Act 1997 (ACT) requires everyone involved in skin penetration procedures (including doctors) to pay for and display an annual business licence assuring patients that the practice meets current infection control standards. The definition of "skin penetration procedure" is set out in the Public Health (Risk Activities) Declaration 2005 (No 1):

skin penetration procedure means any process that involves the piercing, cutting, puncturing or tearing of a living human body but does not include the cutting, shaving or dying of a person's hair or closed ear piercing or the use of test equipment.

closed ear piercing means a process of ear piercing that is carried out on the lower lobe of the ear by means of an apparatus that does not come into contact with the skin and can be operated only by the use of sealed and pre-sterilised disposable fittings.

test equipment means lancets, needles and other similar single-use devices used in the testing of glucose or cholesterol levels.

Drugs

The Drugs of Dependence Act 1989 (ACT)requires records and safekeeping of drugs of dependence, which include amongst others: morphine, codeine, dexamphetamine, pethidine, methadone and fentanyl.

Health Promotion and health administration

The Health Promotion Act 1995 (ACT) establishes a board to fund activities related to the promotion of good health, safety and the prevention and early detection of disease.

Section 6 of the Health Act 1993 (ACT) provides that the following guidelines shall govern delivery of public hospital services in the ACT:

• patients must be given the choice to receive public hospital services free of charge;
• access to public hospital services is to be on the basis of clinical need;
• to the maximum practicable extent, the ACT will ensure the provision of public hospital services equitably regardless of patients' geographical location;
• the Commonwealth and ACT Governments must make available information on the public hospital services patients can expect to receive;
• the Commonwealth and ACT Governments are committed to making improvements in the efficiency, effectiveness and quality of hospital service delivery.

Enforcement

Notification or complaints about public health problems (drinking water quality, food sold to the public, sewer chokes (overflowing), animals in backyards, notifiable diseases, pharmaceutical problems) can be made to the Health Protection Service on 6205 1700. The complaint may ultimately make its way to the Chief Health Officer of ACT Health who reports to Chief Executive then to ACT Health Minister. The office also connects with the ACT Government analytical laboratory. Response time can vary from "10 minutes to 10 years" depending on the nature of the complaint.

Mental Health Legislation

The Mental Health (Treatment and Care) Act 1994 (ACT) provides that, if a mentally ill or mentally dysfunctional person requires and refuses treatment necessary for their own health or safety or the safety of the public, that person may be taken by a doctor or the police to an approved health facility (s 37). Reasonable force and assistance may be used (s 38) and the person must be examined within four hours of detention at the health facility (s 40). The examining doctor may then, if satisfied that the person is mentally dysfunctional or mentally ill and immediate treatment and care is necessary, authorise detention for a further three days in an approved mental health facility (s 41). Within twelve hours of such admission, the Community Advocate and the ACT Civil and Administrative Tribunal (ACAT) must be notified (s 42). The person must be given a proper physical and psychiatric examination within 24 hours (s 43). The Tribunal may extend the involuntary detention by a further seven days on application by a psychiatrist (s 41 (2)). If a seven day extension is granted, the treating doctors determine whether the person meets the criteria for further applications to the Tribunal for extended mental health orders authorising involuntary treatment, care or support. The further mental health orders may authorize detention including authorisation for involuntary treatment, care and support to be provided to the person where they ordinarily live and without restricting their access to the community other than the time required to comply with the order. (Psychiatric Treatment Order, Community Care Order, or Restriction Order).

The ACT Supreme Court has held that an order for involuntary detention should only be made when facts demonstrating the necessity for it have been established by clear and persuasive evidence and the person concerned has been given an opportunity to be heard (Burnett v Mental Health Tribunal (1997).

In addition to mental health orders, the ACAT and the Supreme Court may make other determinations or orders authorizing restricted involuntary treatment under the Mental Health (Treatment and Care) Act 1994 (ACT) for persons who are mentally ill.

For general information, you can call Mental Health on 1800 629 354.

Being a Subject in Medical Research

Assisting medical research is an altruistic act, but should not cause personal detriment to the volunteer. Before consenting to be part of a research project (often a randomised control trial), you should be fully informed of and understand the nature of what is proposed as well as the reasonably likely risks and those of particular concern to you. The doctors involved should declare any conflicts of interest (that is, any financial gain they may obtain from the research). You should be told what will happen to the information obtained and how your privacy will be protected. You should be given the option of leaving the research project at any stage without detriment to your ongoing medical care. These ethical principles of research are included in a variety of international and national guidelines including the international statement of research ethics known as the Declaration of Helsinki and those specific guidelines produced by the NHMRC.

End of Life Issues

Living Wills, Powers of Attorney and Guardianship

The Medical Treatment (Health Directions) Act 1994 (ACT)allows a person of sound mind over 18 years to make a signed and witnessed written direction in accordance with schedule 1, or an oral direction witnessed by two registered doctors or nurses, refusing or seeking the withdrawal of medical treatment, either generally or of a particular kind (ss 6-8). Such a person may also give another power of attorney to refuse of withdraw medical treatment in accordance with the second form in schedule 1.

Before proceeding to follow such a direction, a doctor must tell the patient about the nature of his or her illness, alternative treatments and their consequences, and the consequences of non treatment (s 11). Good faith reliance by a doctor on such a direction shall exempt him or her from any charge of professional misconduct, offence against an ACT law or civil liability.

Such "living wills" or "advance directives" are rarely used. Part of the problem is that people find it very difficult to second guess what circumstances they will be in and what medical treatment they might need. An alternative worth considering is to include the following clause in Form 1 under schedule 1 "I (name) DIRECT that medical treatment (which is not reasonably likely to return me to the following situation which I consider to be a minimum acceptable quality of life) be withheld or withdrawn." This formulation gives your treating doctors the very important information of what you would consider a minimal acceptable level of quality of life. They are then in a much better position to judge what treatment will be in your best interests.

These powers can also be conferred under s 13 of the Powers of Attorney Act 2006 (ACT).

Voluntary Euthanasia

Voluntary euthanasia, "mercy killing" or "assisted suicide" involves the deliberate killing of another non-depressed human being at his or her request in order to reduce pain or assaults on human dignity related to a terminal illness. It has been rendered illegal in the ACT as the result of Commonwealth legislation. The Euthanasia Laws Act 1997 (Cth)schedule 2 amended the Australian Capital Territory (Self-Government) Act 1988 (Cth)to insert s 23(1A): "The Assembly has no power to make laws permitting or having the effect of permitting (whether subject to conditions or not) the form of intentional killing of another called euthanasia (which includes mercy killing) or the assisting of a person to terminate his or her life."

Euthanasia and assisted suicide is legal in the Netherlands and Oregon in the US and controversy continues about law reform in this area. Research suggests that many doctors assist terminally ill patients to die, but do not publicise the fact. In the Diane Pretty case, the European Court of Human Rights held that the human right of respect for privacy (see s 12 Human Rights Act 2004 (ACT)) was engaged where the State prevented a patient exercising her choice to avoid what he or she considered to be an undignified and distressing end to his or her life. This is relevant only to law reform, as any assistance with suicide in the ACT would be contrary to the Commonwealth legislation set out above.

It seems to be settled that doctors following a patient's lawful direction to refuse life-saving medical treatment are not assisting suicide (see Re B (Adult: Refusal of Medical Treatment) (2002) 2 All ER 449).

Palliative Care, Pain Relief and "Double Effect"

Palliative care begins at the point where doctors consider that medical treatment is technically "futile", that is treatment is not reasonably capable of returning the patient to a quality of life he or she would consider meaningful. The focus of palliative care is on pain relief and dying with dignity.

Clare Holland House provides palliative care in the ACT in a tranquil setting on the upper Molonglo River near the Boat House.

The doctrine of medical ethics known as "double effect" allows doctors to continue to relieve pain by incremental doses of drugs such as opiates (morphine) even if the unintended effect of such pain relief is death of the patient (usually from suppression of the neurons in the brain that drive the patient to breathe). This is a standard conception in all palliative care work and is not the same as euthanasia as the primary intention is to relieve pain, not to kill the patient.

In the case of Diane Pretty (2002) 1 FLR 268 at 278, Lord Bingham in the House of Lords considered that the human rights prohibition on "cruel, inhuman or degrading treatment" might be engaged where a public official had forbidden the provision of pain-killing or palliative drugs to a terminally ill patient (see also s 10 of the Human Rights Act 2004 (ACT)).

Withdrawing or Withholding Treatment and "No CPR" Orders

Doctors cannot be forced by relatives of a patient to commence or continue medical treatment that is technically "futile", that is, incapable on reasonable grounds of returning the patient to a meaningful quality of life. The most difficult task where the patient is unconscious or otherwise incompetent is to get good evidence of what the patient would regard as a "meaningful quality of life". United States courts tend to try and obtain evidence from relatives and friends about what the patient would have wished (Cruzan (1990) 497 US 261). English courts focus on what would be in the "best interests" of the patient (Bland's Case (1993) AC 789).

In the absence of a health care power of attorney or valid advance directive, relatives in the ACT do not have the legal authority to consent to the continuance or withdrawal of medical treatment. In such a situation, s 67 of the Guardianship and Management of Property Act 1991 (ACT)permits the Public Advocate to be appointed as guardian. Most doctors will consult with the immediate family of an acutely incapacitated patient as if they had the power to consent to medical treatment.

Where conflict exists between the patient's family and the patient's doctors as to whether medical treatment that is apparently "futile" should be continued, the issue is best discussed before the Hospital's Clinical Ethics Committee. Ultimately, if such disagreement persists, a declaration to lawfully withdraw treatment may have to be obtained from the ACT Supreme Court. If the relatives continue to dispute a withdrawal of treatment decision, the relevant doctors should specify that as a reason for not signing the death certificate should the patient thereafter die. This will then activate the jurisdiction of the Coroner and facilitate a more objective third-party resolution of the issues.

"No CPR" orders may be written in consultation with a terminally ill patient and the patient's family, in accordance with hospital guidelines, to avoid the indignity of life ending in the pressure of an emergency attempt at cardio-pulmonary resuscitation. This might possibly involve deep chest compressions, cardiac "shocks" with a defibrillator, the insertion of intravenous cannulae and giving of drugs such as adrenaline.

Organ Donation by Brain-Dead Persons

Section 45 of the Transplantation and Anatomy Act 1978 (ACT) states that a person has died when there has occurred:

• irreversible cessation of all function of the brain of the person; and
• irreversible cessation of circulation of blood in the body of the person.

Section 35 of the Births, Deaths and Marriages Registration Act 1997 (ACT) requires that a medical certificate must be completed for every death, even where the death has been reported to the Coroner.

If, after reasonable inquiries, a deceased person is shown to have agreed to organ donation during his or her life, written authorisation may be given by the designated officer of a hospital, or the senior available next of kin, for removal of such tissue (Transplantation and Anatomy Act 1978 Part 3). This will not apply if the Coroner needs to hold an inquest (s 29).

Where the person is being kept alive by artificial ventilation and circulatory support, authority for organ donation must not be given unless the patient has been declared brain dead independently by two medical practitioners, each with at least 5 years experience and one of whom is a specialist neurologist or neurosurgeon (s 30). The tests these doctors perform include checking for absence of brain stem function through whether the pupils, or the eyes in general, respond to pain, light or cold water in the ears, and whether the patient has a gag reflex and tries to breath after being disconnected from the ventilator (the blood's rising carbon dioxide level will normally trigger the respiratory centre in the brain stem).

The law operates on the principle that the views that a person expressed while alive about organ donation will be respected once he or she is dead. If the deceased person's views are not known, it is left to the next of kin to decide whether that person should become an organ donor. If the views of the deceased person are not known and no relative can be found, the person may be used as an organ donor although in practice staff seem reluctant in such cases.

The most practical way of ensuring that your views about organ donation are made known to hospital staff is to always carry a signed written statement in your wallet indicating whether or not you are prepared to be an organ or tissue donor, or to register with the Australia Organ Donor Register.

Autopsies

The purpose of a post-mortem examination (an autopsy) performed by a pathologist is to better understand the factors that may have contributed to the person's death. This information may be important for the next of kin (eg. if the person died from an infectious or genetic disease), or for the community as a whole (in identifying or tracing outbreaks of disease; in teaching doctors and nurses; and in checking the quality of the hospital's diagnostic and treatment procedures). The autopsy report will be made available to a medical practitioner nominated by the relatives of the deceased.

Consent is required prior to carrying out a post-mortem examination unless it is ordered by the Coroner. As is the case with organ and tissue donation, the law operates on the principle that the person's expressed wishes, while alive, about the use of his or her body when they are dead, will be respected after their death (Transplantation and Anatomy Act 1978 s 32). Therefore the law on consent for post-mortem examinations and for donation of bodies to medical schools is, in most respects, the same as for organ and tissue donation after death.

The Coroner may dispense with a post-mortem if requested by an immediate family member of deceased or that person's representative if already satisfied "that the manner and cause of death are sufficiently disclosed" (Coroner's Act 1997 (ACT) s 20).

Coronial Enquiries

The ACT Coroners Court is based at the ACT Magistrates Court and the Chief Magistrate is Chief Coroner of the ACT.

A Coroner has a wide discretion in deciding whether to hold an inquest into a reported death or whether to dispense with an inquest and complete an inquiry without a public hearing. (s 14) The Coroner's Act 1997 (ACT)s 13(1) permits a Coroner to hold an inquest into the manner and cause of death of a person who is:

• killed;
• found drowned;
• dies or is suspected to have died, a sudden death the cause of which is unknown;
• dies under suspicious circumstances;
• dies during or within 72 hours after a medical, surgical or dental operation or an invasive medical or diagnostic procedure;
• dies and a medical practitioner has not given a certificate as to the cause of death;
• dies having not been attended by a medical practitioner at any time within the period commencing 3 months prior to the death;
• dies after an accident where the cause of death appears to be directly attributable to the accident;
• dies, or is suspected to have died, in circumstances that, in the opinion of the ACT Attorney General, should be better ascertained; or
• dies in custody.

The ACT public relies on its Coroners to determine the identity of deceased persons, the reason for their death and to refer deaths resulting from an apparent indictable offence to the Director of Public Prosecutions. The Coroner cannot, however, make a finding of guilt or innocence, but rather must establish that a person has a case to answer for the death.

The Coroner may hold an Inquest (a court hearing) to assist in determining the manner and cause of death. These proceedings are generally open to the public and witnesses are called. An Inquest must be held if the death appears to have arisen after or during administration of an anaesthetic. A spouse, parent or an adult child of a deceased person my request an Inquest (Coroner's Act 1997 Part V).

Complaints, Whistleblowing and Initiating Litigation

Complaints and Whistle Blowing

A complaint about a health care provider in the ACT can be made directly to the ACT Health Services Commissioner, who is located within the ACT Human Rights Commission. A person may make a complaint if they are 18 years of age, a guardian or parent, ordered by the court or have been given permission by the Commissioner. A wide variety of grounds for complaints are based on the concept that the doctor or medical provider acted unreasonably. These can include:

• provision of unnecessary services
• improper disclosure of information
• failure to demonstrate consideration or to respect dignity or privacy
• failure to provide adequate information about the service or alternatives
• failure to exercise due care and skill.

(s 39, Human Rights Commission Act 2005 )

If you feel that you have grounds for a complaint, you should take a friend or relative with you, write down your concerns, the questions you want answered and how you would like the complaint to be resolved. A written form is available to lodge a complaint with the ACT Health Services Commissioner. The Commissioner can then

• ask the health care provider to respond directly to the complainant
• undertake an assessment
• offer confidential conciliation
• undertake an investigation and make recommendations for service improvements
• work with registration boards when disciplinary action is appropriate.

If you wish to complain about some aspect of treatment at the Canberra Hospital, ring (02) 6244 2222 and ask for either the "complaints officer" or the corporate-culture term "consumer liaison officer". The direct number is (02) 6244 2974. Staff will permit you to "vent" over the phone, however a complaint in writing is preferred, as details tend to be clearer. The complaints officer will take up the matter in the relevant SMT ("service management team") where the impugned health professional works. The object may be to either register concern, get a written explanation, or a letter of apology if required. A record is kept of every call and conversation. The usual time to get back to the complainant with a "concrete" response is ten days. The SMT area may refer the matter to the clinical review committee (doing root cause analysis of adverse events to see if a pattern is emerging) or clinical ethics committee (to better shape the complaint and support the complainer, or "whistleblower", if required).

If compensation is sought, the Hospital's solicitor (the ACT Government Solicitor) gets involved. The ACT Health Services Commissioner may become involved to organise conciliation. Better success for some complaints claims occurs if you write directly to the office of the ACT Minister for Health. All proceedings during conciliation are confidential and information obtained cannot be used as evidence in court. If a settlement is reached at the end of conciliation, a deed of release may be prepared, which will set out the obligations of both parties. In some cases, this may involve the provider paying compensation to the patient. A patient may seek legal advice before signing the release but, once it has been signed, he or she will be unable to take any legal action against a provider who is observing the terms of the settlement.

If your complaint is about a person who is employed by the ACT and is engaging in conduct amounting to a substantial and specific danger to the health or safety of the public, then you may make a public interest disclosure to the appropriate agency (ie. public hospital). A person lodging a complaint must establish that the complaint is reasonable, it was made bona fide, it was made in the public interest and that it was not vexatious. This complaint will be protected from unlawful reprisals (ie. sacking) by the Public Interest Disclosure Act 1994 (ACT).

Registration Boards and Professional Misconduct

The Health Professionals Act 2004 (ACT) established a unified registration scheme that has brought together under one Act a number of health professional registration legislation and health profession boards. It involved a staged transfer of all health profession registration boards under one umbrella piece of legislation encompassing all matters related to the regulation of health professions in the ACT. This new legislation encouraged an awareness of the rights and responsibilities of users and providers of health and professional services, assisted in the maintenance of a minimum standards of health service providers through investigation and resolution of complaints about registered health professionals, and ensured that health and professional services are provided by people who are suitable and able to provide them.

A report of professional misconduct can be made under Part 9 of the Health Professionals Act 2004 to a health profession board (or a complaint can be lodged under s 8 of the Human Rights Commission Act 2005). The required standard of practice is "the exercise of professional judgment, knowledge, skill and conduct at a level that maintains public protection and safety" (s 18(1)). A professional standards panel may inquire into this and require remedial action be taken where a health professional is contravening or has contravened the required standard of practice, or does not satisfy the suitability to practice requirements (s 11).

The Health Professionals (Special Events Exemptions) Act 2000 (ACT)allows visiting health professionals to provide health services in relation to certain special events, so declared by the Minister, without being registered under ACT laws.

The Health Professionals Act 2004 (ACT) allows each regulated health profession to establish a board to assist the Minister in the administration of the Act. It is not the role of health profession boards to achieve an outcome for the consumer by virtue of compensation or an apology. The board's role then, is to investigate practitioners' practices in order to achieve higher standards for the community as a whole. The legislation provides that each health profession board must have at least two community representatives.

Until 1 February 2009, the ACT Health Professionals Tribunal, established by the Health Professionals Act, was responsible for reviewing decisions from health profession boards and deciding whether a health professional meets the required standards for practice. On 2 February 2009, the Health Professionals Tribunal was abolished and its jurisdiction was conferred on the newly established ACT Civil and Administrative Tribunal (ACAT). Section 66(2) of the ACT Civil and Administrative Tribunal Act 2008 (ACT), together with s 44(2) of the Health Professionals Act, gives the ACAT power to make a wide range of orders, including suspension or removal from the register as well as imposing conditions or requiring the health professional to take part in a review of their professional practice, or to complete educational or other professional development courses as well as to undergo medical psychiatric or psychological assessment or counselling. The ACAT is required to provide a written notice of any order made within 7 days (s 59, ACAT Act), and must provide written reasons for its decision if requested by a party within 14 days after the decision (s 60, ACAT Act). An appeal may be made to the Appeals Division of the ACAT (s 79, ACAT Act). An appeal from the ACAT decision on appeal may be made to the Supreme Court on a question of fact or law, with the leave of the Court (s 86, ACAT Act).

Commencing Litigation for Professional Negligence

In seeing a solicitor to commence proceedings to recover damages for medical negligence you are likely to be asked to sign a costs agreement providing for payment for legal services at a rate of approximately $300 per hour. If the case is taken on as "no win no fee", this won't be sought until settlement. If you lose a "no win no fee" case, the question of whether you have to pay the costs of the other side or not will depend on the terms of your costs agreement and the costs order, if any, made by the court. Normally, if the case is settled prior to the court hearing, the plaintiff doesn't have to pay the costs of the defendant. However, there are disbursements you may have to pay, even in "no win no fee" cases, include a filing fee ($575), setting down fee ($607) and subpoena ($52).

Many plaintiff firms provide the first appointment free of charge so that the solicitor can determine whether you have a reasonable claim or not. The solicitor will need to know the factual chronology, preferably prepared before the meeting. It must be mentioned however, that under Part 2.2A of the Civil Law (Wrongs) Act 2002 (ACT),a doctor may give an apology (an oral or written expression of sympathy or regret) which cannot be admissible as an express or implied admission of fault or liability.

Once a doctor willingly accepts a patient's request for a medical opinion, they owe that patient a duty of care. The doctor has a duty to achieve the best outcome for that patient, but is under no obligation or duty to cure them. The standard of care in general terms will be that of a reasonable doctor in the defendant's position (s 31E). The court may, however, decide upon a 100% reduction of damages for contributory negligence if it is just and equitable to do so, with the result that the claim for damages is defeated (s 31J).

To commence litigation proceedings against a doctor, you must have sent the doctor a written notice of claim (not the actual legal statement of claim) within 9 months of the event causing damage or when symptoms of it first appeared, or within 4 months of you first seeing a lawyer about it. The doctor must respond to that notice within a prescribed time (ss 31O-P). The essence of that response should be that the notice of claim complies with the legislation, whether liability is admitted or denied, the percentage of contributory negligence claimed, whether any offer is accepted or rejected and what is a reasonable estimate of damages (s 31Y).

The parties may agree to one person being the expert witness for both of them (s 31ZX). If no such joint expert is appointed, the court may do so, either on application by one party, or on its own initiative (s 31 ZY). The role of that expert will be to assist the court on the issues impartially and not to be an advocate for a party (s 31 ZYA).

In the ACT there is a cap on damages for loss of weekly earnings (to three times average weekly earnings). At present, there is no cap of damages for pain and suffering, general damages or continuing care. In the ACT the discount rate for the present value of your future economic loss damages award is 3%. This can make a huge difference to the damages awarded to someone who is catastrophically injured.

Commencing a medical negligence action is a very stressful and expensive undertaking. It is very unjust that this remains the only practical means of obtaining compensation after medical error. It must be stressed however that a medical negligence action only provides monetary damages for negligent conduct not merely for an adverse outcome.

Contacts, Links and Resources

Web Sites

ACT Health http://www.health.gov.au/

ACT Health Services Commissioner www.hrc.act.gov.au

ACT Government Legislation www.legislation.act.gov.au

ACT Civil and Administrative Tribunal www.acat.act.gov.au

ACT Coroners Court www.courts.act.gov.au/magistrates/index.html

ACT Ministerial Advisory Council on Ageingwww.dhcs.act.gov.au/wac/ageing/advisory_council_on_ageing

Aged Care Standards and Accreditation Agency www.accreditation.org.au

Arcadia House Withdrawal Centre www.directionsact.com/arcadia

Australian and New Zealand Food Regulation Ministerial Council www.health.gov.au

Australian National University Sexuality Department http://sa.anu.edu.au/index.php?page=92

Australian Organ Donor Register www.medicareaustralia.gov.au/organ

Calvary Health Care ACT www.calvary-act.com.au

Canberra Connect www.canberraconnect.act.gov.au

The Canberra Hospital www.canberrahospital.act.gov.au

Canberra Sexual Health Centre www.health.act.gov.au/sexualhealth

Department of Veterans' Affairs www.dva.gov.au

Disability ACT www.dhcs.act.gov.au/disability_act

Drug Education Forums (ACT Dept of Education and Training) www.det.act.gov.au/teaching_and_learning/curriculum_programs/student_wellbeing/drug_education

Health Protection Service www. health.act.gov.au

Healthcare Consumers' Association of the ACT www.hcca.org.au

Marie Stopes International www.mariestopes.com.au or www.abortionhelp.com.au

Sexual Health and Family Planning ACT: www.shfpact.org.au

National Health and Medical Research Council www.nhmrc.gov.au

Ted Noffs Foundation www.noffs.org.au

Winnunga Nimmityjah Aboriginal Health Services www.winnunga.org.au

Contact Numbers

ACT Community Health Intake Line (Alcohol and Other Drugs Helpline; Aged Care; Breastscreen; Cancer support; Child health services; Children & parenting; Community Nursing; Corrections Health; Dental; Diabetes; Home support; Migrant health; Nutrition; Women's health; and Youth health): (02) 6207 7777

The Capital Gynaecology Centre (02) 6299 5559

Child and Adolescent Mental Health Triage: (02) 6205 1971 (Business Hours -- see Mental Health Crisis Assessment Team below for out of hours response).

Commonwealth Rehabilitation Service (CRS) 1800 277 277

Health Protection Service (24hrs) (to report disease outbreaks or leave complaints about food sold and/or served in public places, water, air, sewerage and land pollution problems): (02) 6205 1700

Mental Health Crisis Assessment Team (24hrs): 1800 629 354

Sexual Health and Family Planning ACT (unplanned pregnancy counselling): (02) 6247 3077

Marie Stopes International (termination of pregnancy): 1800 003 707