Source: https://www.alzheimer-europe.org/Policy-in-Practice2/Country-comparisons/2016-Decision-making-and-legal-capacity-in-dementia/Austria
Timestamp: 2019-11-21 01:33:43
Document Index: 254303362

Matched Legal Cases: ['§ 284', '§ 10', '§ 3', '§ 4', '§ 5', '§ 14', '§ 14', '§ 11', '§ 13', '§ 6', '§ 7', '§268', '§268', '§268', '§282', '§276', '§267', '§55']

Austria - 2016: Decision making and legal capacity in dementia - Country comparisons - Policy in Practice - Alzheimer Europe
The recent changes in guardianship law, which came into force on 1 July 2007, allow for two other possibilities, namely consent by a next of kin who has been granted agent’s authority (Vertretungsbefugnis nächster Angehöriger) or consent by a person (i.e. a trustee) who has a durable power of attorney (DPoA/Vorsorgevollmacht).
For example, it is possible for a competent person to appoint someone to make health care decisions on their behalf at a time in the future when they no longer have the necessary capacity to make health care decisions themselves. This is called a durable power of attorney for legal representation (referred to hereafter as DPoA). The DPoA only becomes effective when the person granting it loses legal capacity, insight and judgement or the ability to express him/herself (as attested by a medical certificate). A DPoA can cover all medical decisions (including serious medical treatment with lasting effect) provided that it was drawn up before an attorney-at-law, notary public or court and that the power to make such decisions was correctly registered in the document.
In the exact same manner as patients (or their representatives) must consent to all forms of medical treatment, they can refuse treatment. If a guardian’s refusal of treatment would endanger the health of the person in question consent to treatment can be given by the Court. Treatment without consent is forbidden by the Penal Code.
Consent to research/ clinical trials
Participation in clinical trials is governed by the Medicaments Law (N°185) of 1983 (Leenen et al., 1993). Participants must consent to their participation and such consent is only valid if they are capable of managing their own affairs, able to understand what is involved, aware of the significance of the trial and aware of any dangers involved. If a person fulfils these conditions and decides to participate, s/he retains the right to withdraw from the trial at any time. A person who has been interned (in a psychiatric ward or a nursing home) cannot give consent to clinical trials. According to § 284 of the General Civil Law, a guardian can only give consent in the exceptional case that the treatment provides immediate benefit to the health of the person in question. Authorisation from the Court is necessary.
Paragraph 8c of the KAKuG states that founders of hospitals and clinics are obliged to set up ethics committees to assess clinical tests of medicines and medical products and the application of new medical methods in the hospital or clinic. Assessments must pay particular attention to the people taking part in the research, the relationship between the target and the scientific meaningfulness and between usefulness and risk, the manner in which experimental subjects are selected, the way information in given and consent obtained and the precautions against possible damage to participants.
The legal status of advance directives in Austria
According to § 10 of the Hospital Establishment Law of 1957 (KAKuG), it is obligatory when recording a patients’ case history in hospitals and clinics to document instructions from the patient regarding certain forms of treatment which should not be carried out in the case of future incapacity. These instructions must then be taken into account by doctors in the event of the patient’s future incapacity.
In Austria, it is possible to write an advance directive (sometimes called a “living will”) (“Patientenverfügung”) and/or to appoint a trusted person to act on one’s behalf (“Vorsorgevollmacht”/DPoA). The duties of the trusted person may be limited to financial, administrative and/or care issues, but may also (or alternatively) cover health care decisions.
On 1 July 2006, the 55th Federal Act on Living Wills (the “Patienten-verfügungsgesetz – PatVG”) came into force. This act regulates the requirements and effectiveness of living wills. The law divides living wills into those that are binding and those that are non-binding.
A person making a living will should have the capacity for insight and judgement (§ 3). In a binding living will, any medical treatments that are to be refused must be concretely described or be clear from the overall context of the document. It must be clear that the person making the living will appropriately evaluate the consequences of the living will (§ 4).
Before writing the living will, the person must consult a doctor in order to obtain information about the nature and consequences of the living will for medical treatment. The doctor providing such information must also confirm the person’s capacity for insight and judgement by indicating his/her name and address and signing the document. S/he must also confirm that the person has appropriately evaluated the consequences of the living will and give examples to demonstrate in what way (§ 5).
If the doctor providing information in this context is of the opinion that the patient does not have the necessary insight and judgement to draw up a living will, s/he shall document this, if applicable, in the patient’s medical history (§ 14).
According to the law proposal, a relevant advance directive can also be made orally by a hospitalised patient. For non-hospitalised patients who have not personally written or signed their advance directive, it must contain the signature of a doctor who certifies that s/he has provided the person with the relevant information relating to the decisions made by the patient.
The informing and attending doctor must include the living will in the patient’s clinical records. If the living will is drawn up outside the hospital setting, the doctor must include it in the medical history (§ 14).
The federal act on living wills does not explicitly state what can be included in the living will but it does state that it can contain additional comments such as the designation of a specific confidant, the refusal of contact with a specific person or the obligation to inform a specific person (§ 11).
The living will cannot be used to refuse treatment that has been imposed on a person by specific legal provisions (§ 13).
The living will be considered binding if it was drafted in writing, if the date was indicated in the presence of a lawyer, a notary, or a legally trained associate of the patient advocacies, and if the patient was informed about the consequences of the living will as well as about the possibility to revoke it at any time. The person witnessing the dating of the document must also personally sign the document (§ 6).
A living will is valid for 5 years from the date it was signed unless a shorter period of time was specified. It can be renewed for a further five-year period as long as the formal requirements previously mentioned have again been fulfilled. Every amendment is treated in the same way as a renewal and the expiry date is reset for the entire living will. It does not lose its binding character once the patient is unable to renew it due to incapacity to understand, judge or express him/herself (§ 7).
A DPoA can be revoked at any time even, even after the person who made it has lost capacity, insight or judgement.
The 136th Federal Law of 2 February 1983 on Trusteeship/Guardianship for Handicapped Persons (Law on Trusteeship/Guardianship Law) resulted in the repeal of several paragraphs relating to incapacitation in the Order on Incapacitation of 28 June 1916. Due to the change in Guardianship Law effective as from 1 July 2007 (Sachwalterrechts-Änderungsgesetz BGBl 2006/92) guardianships are to be restricted to those cases in which the appointment of a guardian is unavoidable by legislation offering alternatives to guardianship, i.e. agents authority granted to next of kin or durable powers of attorney for legal representation.
This law refers to §268 of the General Civil Code which states that a person who is unable to manage his/her own affairs without risk of personal disadvantage can have a trustee appointed if there is no less restrictive method of protecting his/her interests.
People with dementia who need a guardian are now covered by the Law on Trusteeship. According to §268 of the General Civil Code,
"If a person who suffers from a mental illness or who is mentally handicapped is unable to look after some or all of his own affairs without risk of disadvantage to himself, a trustee shall be appointed for this purpose on his own application or by order of the authorities."
A trustee (the term which will be used hereafter for guardian) should not be appointed if the person concerned could be assisted in a way which would be less intrusive or extreme, e.g. by a family member or a private or public institution. One such possibility would be to use a durable power of attorney, provided that the person had sufficiently legal capacity to write a valid durable power of attorney. Nevertheless, the repeal of the Order on Incapacitation in 1984, which meant that people could no longer be declared "legally incompetent", resulted in a huge increase in the number of trustees appointed (Blaha, 1999). Awareness of this problem has been increasing, and new research by appointment of the Ministry of Justice has been carried out.
As a “legal representative” the powers of the trustee are determined on an individual basis taking into account the extent of the disability, as well as the nature and scale of the affairs to be managed (§268 of the Law on Guardianship). The trustee can be entrusted with the management of the person's individual affairs such as defence against a claim or entering into and handling a legal transaction, or with the management of all the affairs of this person. However, for "strictly personal decisions"such as the right to bodily integrity and the choice of one's place of abode, the trustee can only decide on the person's behalf if the latter is incapable of understanding or making a judgement. If the trustee is not only entrusted with single affairs, s/he must be in touch with him/her at least once a month (this is called “Personensorge” nach §282)
According to §276 of the General Civil Code, guardians can apply to the court for remuneration and to have their expenses reimbursed. Usually, they receive 5% of the ward’s net income excluding certain benefits and allowances that the latter may receive. An additional 2% of the ward’s assets exceeding EUR 10,000 may also be granted.
If the trustee does not act on behalf of the ward, s/he is liable for all resulting damage (§267 of the General Civil Code). Lawyers, public notaries or trustees from a non-governmental organisation must fulfil higher standards than trustees close to the ward.
A living will concern the advance refusal of medical treatment at a time when the grantor no longer has insight or judgement or cannot express him/herself. It can be considered relevant or binding. For it to be binding, it must contain specific details of the treatment to be refused and must have been drawn up before a lawyer, notary or patient advocacy organisation. In addition, it must be renewed after five years.
Compensation and/or reimbursement of expenses should be handled as stipulated in the DPoA. There is liability of damage according to the rules laid down for trustees.
Consensual divorce, in accordance with §55a of the Marriage Law, is based on a strictly personal decision. Surrogate decision making is therefore not permitted.
A person for whom a trustee has been appointed does not lose the right to vote (or to be elected).
Where there is a trustee, wills can be made in a particular way. The person who is making the will must make a statement of will before the court or before the notary, if the court has declared it to be a part of the decision related to the appointment of a trustee.