54 Resolving post-ACP disputes in South Australia: elder-inclusive mediation in the shadow of the law

<h3></h3> South Australia (SA) operates an elder-inclusive mediation service, and this presentation will show that it is an appropriate model for resolving Advance Care Directive (ACD) and health disputes and building decision-making capacity in the family and systems context. Elder-inclusive mediation is a means of exploring options and solutions, through the lens of the needs and wishes (including binding medical refusals) a Person has written in their ACD. This process can help families avoid intervention by the South Australian Civil and Administrative Tribunal (SACAT), uphold the Person’s wishes, and transform conflict. Learnings will be shared about the implementation of dispute resolution through South Australia’s Advance Care Directives Act (2013) (ACD Act) and Consent to Medical Treatment and Palliative Care Act (1995) (Consent Act), and its usefulness for post-advance care planning issues across the country. OPA SA’s work is significantly enlivened by organisational drivers, such as reduction of unnecessary guardianship orders, but equally and importantly a passion for preserving valid advance care planning documents, and upholding the rights, wishes and preferences of vulnerable of South Australians. OPA SA is also committed to professional ethics, principles and standards of dispute resolution, and the Office’s statutory boundaries and responsibilities. The presentation will demonstrate that all these demands can be satisfied under the South Australian ACD and Consent Acts. A case study will outline a framework for elder-inclusive mediation and supported decision-making. It describes the design of mediation which accommodates the unique features of the Person and their supporters (interested parties), and honours the core ethics of mediation (confidentiality, neutrality, wishes, self-determination, power balance), and the requirements of the law. High rates of agreement are achieved through this process and often obviate the need for SACAT applications. Inclusion of the ‘voice’ of the Person who made the ACD in the mediation process – within physical and cognitive constraints – helps to centralise the wishes of the Person and the parties’ shared interest in their care and wellbeing, while decentralising entrenched conflict and family dynamics. South Australia’s ACD and Consent Acts aim to truly hold paramount the wishes of the Person, and provide mechanisms for these wishes to be upheld, particularly in the presence of family conflict. SA now has 12 years of experience with advance care planning disputes in a statutory context and will outline the model, learnings and opportunities of using elder-inclusive mediation in the shadow of the law.