Australian Indigenous people and treatment decision-making at end-of-life

This article analyses Australian law and literature to identify the key cultural and legal considerations that can arise in medical treatment decision-making with Aboriginal and Torres Strait Islander peoples at the end-of-life. The authors explore how First Nation peoples’ cultural values, connection to Country, family, and community, history, and health care experiences, intersect with end-of-life medical treatment laws, providing valuable insights for lawyers, policymakers and health practitioners.


Method
Our analysis was undertaken as part of an Australian government-funded national training program, End of Life Law for Clinicians (ELLC). 15The training program, established in 2017, delivers online modules and workshops for medical practitioners, nurses, allied and other health professionals, and health professional students about Australian end-of-life decision-making laws.The training is also relevant and available to lawyers, policymakers and others.
Country is defined as follows: 'Country with a capital "C" refers to the culturally defined homelands of Aboriginal and Torres Strait Islander people, for whom "Country" is a complex term, encompassing cultural practices, customs, law, place, language, spiritual beliefs, material sustenance, family and identity all in relation to the lands, waterways and seas to which people are connected.'   A new online module exploring end-of-life law when caring for Aboriginal and Torres Strait Islander peoples was developed by the ELLC training program.To support module development, we reviewed Australian case law, state and territory legislation, and literature (including searches of Google Scholar and PubMed) to identify and examine legal, cultural and health care considerations relevant to end-of-life and Indigenous people.Websites of health professional and palliative care organisations, health departments from all jurisdictions, and guardianship bodies were searched for relevant resources including end-of-life policies and guidelines.Reference lists of relevant literature were reviewed, and potentially relevant documents known to the authors were also considered.
The key considerations, themes and legal issues identified were categorised into various legal domains, drawing on a comprehensive mapping exercise previously undertaken by the ELLC training program. 16That mapping identified the following 11 (at times overlapping) domains: consent to treatment; decision-making capacity; withholding and withdrawing life-sustaining treatment; advance care planning; substitute decision-making; providing pain and symptom relief at the end-of-life; futile or nonbeneficial treatment; emergency treatment; managing conflict/complaints and dispute resolution; children and end-of life decision-making; and voluntary assisted dying (VAD).

Findings
The following sections will discuss our key findings from the analysis of Australian legislation, case law and literature on end-of-life law and Aboriginal and Torres Strait Islander peoples.

Legislation
Human rights legislation in the Australian Capital Territory (ACT), Queensland and Victoria reinforces that First Nations People have distinct cultural and human rights. 17In these jurisdictions, public authorities, including hospitals and health services, must act consistently with these rights. 18Queensland law specifically recognises the right to health services. 19tate and territory guardianship and medical treatment legislation provides a framework for medical treatment decision-making for a person with impaired decisionmaking capacity. 20These laws apply to all people, regardless of cultural background, but provide only broad guidance for decision-making with Indigenous people.
The laws seek to preserve and maintain an Aboriginal and Torres Strait Islander person's cultural values, beliefs, customs, protocols and supportive relationships (for example, with family and community) when the person lacks capacity.Most state and territory legislation recognises that an individual's cultural and linguistic environment and values should be promoted, maintained and taken into account in decision-making for a person with impaired capacity. 21In Queensland and the ACT, the importance of maintaining the person's Aboriginal or Torres Strait Islander cultural and linguistic environment and values, including Aboriginal tradition or Island custom, is specifically recognised and must be considered. 22n relation to communication, some legislation enables a person to receive assistance from an interpreter to make an Advance Care Directive. 23Several jurisdictions also recognise that a finding of impaired decision-making capacity in someone should not be based on that person's inability to speak English, or engaging in or making decisions because of particular cultural or religious practices or beliefs. 24

Health policies, guidelines and regulatory instruments
Health policies and guidelines vary between jurisdictions, and most do not provide specific guidance on end-of-life decision-making and Indigenous people. 25n Queensland and New South Wales (NSW), some guidance is provided on obtaining consent to medical treatment, communication, and cultural considerations in delivering health care. 26In Western Australia (WA), Queensland and NSW, there are also resources for health professionals caring for Indigenous people wanting to access VAD, but similar resources do not exist in the other states where VAD is operating. 27espite this, most health professional codes of conduct require health professionals to provide Culturally Safe and Culturally Responsive care, and to respect a person's diverse cultural practices and beliefs relating to death and dying. 28National safety and quality standards for health services and aged care also require delivery of Culturally Safe and Culturally Responsive care. 29

Case law
We found very few Australian cases that focus on end-oflife decision-making for Indigenous peoples.Most do not consider the impact of the person's cultural values and beliefs or family relationships in decision-making.For example, the cases Application of a Local Health District; Re a Patient Fay [2016] NSWSC 624 and Re PVM [2000]  QGAAT 1 concerned determinations of decision-making capacity, refusal of treatment and withholding of treatment.However, there was no discussion of the patients' Aboriginal cultural values, beliefs and practices in decision-making.Some state and territory guardianship tribunals have considered the role of family and community; maintaining cultural, spiritual, and family connections; and returning to and connections with Country in applications for the appointment (or review of appointment) of a guardian or administrator for an Aboriginal and/or Torres Strait Islander person with impaired capacity. 30These cases focus on whether there is a need for a guardian for broader health care, financial and personal decisions (such as accommodation) rather than specific decisions about end-of-life treatment.However, they provide some guidance as to how tribunals may consider a person's culture and family relationships in determining guardianship applications.
There was brief consideration of an Aboriginal person's culture in relation to continuation of artificial nutrition and hydration in Re Herrington [2007] VSC 151.There, the hospital decided to cease artificial feeding and antibiotics and provide palliative care to an Aboriginal woman in a persistent vegetative state.The patient's partner and family applied for an order that continuing medical treatment was in her best interests.They believed she was responsive, and that food and drink should continue to be provided, in accordance with Aboriginal cultural values.The family also argued that 'Aboriginal culture involves caring for people who are unwell'. 31illiams J considered 'everything said about the cultural values of Aboriginal society' but accepted the unanimous medical evidence that continuing treatment would be futile, and may hasten death or cause unnecessary pain and suffering. 32The decision attracted some criticism for not giving sufficient weight or consideration to Aboriginal cultural values and human rights raised by the patient's family, or Aboriginal cultural rights (a requirement of the Charter of Human Rights and Responsibilities Act 2006 (Vic)). 33here was also discussion of cultural practices in decision-making in Livermore v The New Children's Hospital Westmead [2002] NSWADT 111.This case involved a claim of discrimination against the applicants during the time their infant child was in the respondent's care.Life-sustaining treatment was withdrawn from the child after an unsuccessful operation.The applicants alleged discrimination on the grounds of race and provision of goods or services in contravention of the Anti-Discrimination Act 1977 (NSW).
A central argument was that clinicians treated the applicant father differently and less favourably than the applicant mother because his appearance was Aboriginal.The applicants gave evidence that staff addressed the mother in preference to the father even though Aboriginal culture required the man of the family to deal with major questions relating to the family.This would then be  related back to the family so that each member can have some input in the decision-making process. 34 showing preference in addressing the mother, the father 'was humiliated and shamed within his cultural framework'. 35The Tribunal ultimately concluded there was no discrimination by the respondent.
Re Herrington and Livermore provide useful guidance for lawyers and health practitioners about cultural considerations that may arise in the context of decision-making with Indigenous patients, families and communities at the end-oflife.
Due to the recency of the operationalisation of VAD laws in Australia, there are very few reported decisions relating to VAD.To date, no reported cases have involved consideration of Indigenous cultural values, beliefs or decision-making practices.Wake v Northern Territory of Australia (1996) 109 NTR 1 involved a constitutional challenge to the validity of the now-repealed Rights of the Terminally Ill Act 1995 (NT), which permitted voluntary euthanasia in the Northern Territory (NT) between 1996 and 1997.The plaintiffs included an Aboriginal Uniting Church Minister, the Reverend Djiniyini Gondarra.One of the key arguments was that the Act violated an inalienable right to life and was therefore invalid.This case was decided on constitutional law grounds, and the judgment did not discuss end-of-life decision-making, or Aboriginal and/or Torres Strait Islander cultural values or beliefs.

Literature review
The literature revealed that end-of-life legal concerns for Indigenous people arise primarily within two domains: consent to treatment and approaches to decision-making.Six other domainsadvance care planning, withholding or withdrawing life-sustaining treatment, futile and nonbeneficial treatment, managing conflict, administering pain and symptom relief, and VADwere also identified (these will be referred to as treatment decisions).Across all domains, two core themes emerged about approaches to end-of-life decision-making: first, the importance of clear, honest and Culturally Safe and Respectful communication with patients, families, and community; and second, for some Indigenous people, the role of collective decisionmaking with family and community.
There is significant diversity among First Nations People, and different preferences, beliefs and values about end-oflife decisions and medical treatment.Accordingly, the findings presented below may not apply to everyone.It is important to discuss with every patient (and, with consent, their family or community) their preferences, and identify individual needs.

Consent to medical treatment and communication
Consent to treatment is valid when it is given freely and voluntarily, a person has decision-making capacity, and it applies to the circumstances. 36Decision-making capacity is presumed unless a person is unable to comprehend, retain, use and weigh the relevant information. 37The literature reported additional factors relevant to obtaining consent from Indigenous people (see Figure 1, on the following page).
Clear, honest and respectful communication between health care providers, patients and families, and strong relationships based on trust and rapport underpins end-oflife decision-making with Aboriginal or Torres Strait Islander peoples.Good communication and rapport with patients and families allows the person's values and cultural beliefs associated with dying to be explored and understood, and their preferences followed (for example, returning to and dying on Country or involving family and community in decision-making). 38It also enables accurate determinations of decision-making capacity, and effective consent and decision-making processes.
Aboriginal and Torres Strait Islander health practitioners and health workers play a significant role in supporting communication, obtaining consent, and decision-making.These health professionals coordinate and provide specialised, holistic, Culturally Safe and Culturally Responsive health services to Indigenous people at the end-of-life. 39boriginal and Torres Strait Islander health workers provide essential emotional, social and cultural support to patients with a life-limiting illness and their families. 40They are an important conduit between the individual, family and clinical team in hospital and health services, and the community, understanding language (verbal and non-verbal) of the people they care for, as well as Indigenous cultural beliefs and knowledge. 41ther relevant factors include support for communication, including interpreters, setting aside more time for yarning (conversations), and the importance of kinship and culture in decision-making. 42n many Aboriginal communities, child rearing practices are communal, often involving extended family. 43Treatment decisions for children may be a shared responsibility of the child's parents, extended family and community members, and the child's biological parents. 44In Torres Strait Islander cultures, consent to medical treatment may be the responsibility of the child's cultural parents in accordance with Ailan Kastom traditional adoption and child rearing practice. 45t the end-of-life, advance care planning processes may be undertaken to determine a person's values and preferences about treatment if they lose decision-making capacity in the future. 46Many First Nations People may prefer to communicate about the end-of-life through advance care yarning. 47This approach, embodying traditional yarning practices, involves people connecting, storytelling, and sharing information. 48In the end-of-life context, yarning supports discussions about treatment and care preferences and needs, and cultural and spiritual values and beliefs.If the person desires, it can include formally documenting these in an Advance Care Directive or other planning documents (but this is less common among Indigenous than non-Indigenous people). 49For many Indigenous people the 'death' and 'dying' may not be appropriate, therefore care should be taken to use the person's preferred terminology in advance care planning and other end-of-life conversations. 50llective decision-making In First Nations Peoples' kinship systems and Lore, the individual, family, and community are innately linked. 51onnection to family, community and Country is also fundamental to Indigenous peoples' health and wellbeing. 52hile medical treatment laws in Australia generally focus on individual autonomy, some Indigenous people may prefer collective decision-making, a cultural approach involving collaborative and consultative decision-making with family, Elders and/or community. 53he critical role of family and community in supporting decision-making was a core theme that arose throughout our analysis.A health care decision may consider the needs of family and community and therefore a patient may seek input from others before deciding. 54Patients may identify the 'right person' within their family or community for involvement in the decision-making process if this is a cultural protocol. 55Decisions may become shared decisions, made within family contexts and within a wide network of supportive relationships and responsibilities.They are not decisions of one Person: the partner, the parent or the child. 56wever, decision-making preferences vary among individuals, with some Indigenous people preferring to make decisions independently.
Decisions may be influenced by traditions, cultural protocols, kinship, and family dynamics.For example, decision-making may be led by a certain person, such as the eldest person in the family, 57 or Elders or others within kinship groups may be consulted. 58The decision-maker recognised by guardianship and medical treatment laws may not be the same as the cultural decision-maker, based on cultural Lore and protocols. 59Some decisions may only be made by male or female family members if considered Men's or Women's business. 60ome jurisdictions' guardianship and medical treatment legislation (and health policies) support a person's choice to involve family or community in decisionmaking, as well as to decide independently.For example, in the ACT, South Australia and Tasmania, a person's wish to involve family and relatives in decisionmaking, and to make decisions collaboratively with family and community, is recognised. 61Queensland's legislation acknowledges and respects the role of families and significant persons in the adult's life to support the adult to make decisions. 62In all jurisdictions, a person's decision to involve or not involve family or community in decision-making should be respected. 63tate and territory guardianship and medical treatment legislation provides a framework for treatment decisions to be made by a 'default' decision-maker if a person does not have capacity and there is no Advance Care Directive or appointed decision-maker. 64In all states and territories except the NT and Victoria, a person's close relative or friend can be a default decision-maker. 65This could be an Indigenous person's extended family, friends and community representatives. 66In Queensland and SA, relatives under Aboriginal tradition, Torres Strait Islander custom, or Aboriginal or Torres Strait Islander kinship rules are recognised as default decision-makers. 67In SA, this includes an adult legally married to a person in accordance with Aboriginal tradition. 68There may be more than one possible default decision-maker, which may be the case if the person has many family members under kinship protocols. 69ueensland has further provisions relating specifically to Indigenous people.For example, whether a potential guardian is compatible with the person, ie whether they have appropriate cultural or social knowledge or experience, is a consideration the tribunal must take into account when appointing a guardian for the adult. 70Another example is that, in order to be a statutory health attorney (default decision-maker), a person must be 'culturally appropriate' to exercise decision-making power. 71n the NT, a person related to the adult in accordance with Aboriginal customary law or tradition may be an 'interested person' and consulted by a decision-maker when determining what is in the adult's best interests. 72n clinical practice, when there are multiple family members involved in decision-making and the person does not have capacity, decisions are generally reached through shared decision-making at family meetings.This involves the person's clinical team bringing together close and extended family, Elders and possibly other community members to discuss and decide about the person's care and treatment. 73ncluding Aboriginal and Torres Strait Islander health care 56 Tossy Baadjo Nangala, Gracie Mosquito Nangala and McCoy (n 53).57 professionals in meetings (with the family's consent) can facilitate decision-making and obtaining consent. 74eatment decisions Issues relating to withholding or withdrawing life-sustaining treatment, futile or non-beneficial treatment, administering pain and symptom relief, and VAD also arose in the literature.
For many Indigenous people, decisions about withholding (not starting) or withdrawing (stopping) lifesustaining treatment may be influenced by the person's cultural, spiritual and religious beliefs, and connection to Country, family and community. 75For example, a person may refuse life-prolonging treatment and/or transfer to hospital or care facilities in order to pass away on Country or remain close to community. 76A related challenge is provision of treatment that is unnecessary or unlikely to benefit the person.Although the law does not require health professionals to provide treatment that is futile or non-beneficial, research indicates that such treatment is often provided at the end-of-life. 77For Indigenous people, non-beneficial treatment can result in unnecessary hospital admissions, false hope of recovery, or deterioration preventing the person from returning home to pass away. 78uch outcomes can cause considerable emotional and spiritual distress to the person and family. 79onsiderations relating to administering pain and symptom relief were also identified.These include beliefs among some Indigenous people that suffering is a necessary part of sickness and death, uncertainty about pain medication and fear of addiction. 80Concerns that strong pain relief may prevent a person from communicating, spending time with family, or passing on traditional knowledge were also raised. 81These factors may lead to the refusal of pain and symptom relief at the end-of-life.
In some communities, fear of payback (practices of punishment or retaliation under cultural Lore) may arise, 82 where a dying person's community feel the person was poisoned or their death was hastened by care providers. 83ame may be directed at family members or health professionals administering the medication. 84This may make health professionals reluctant to provide pain relief. 85Clear communication about pain relief can reduce this fear and dispel myths.
VAD was identified as an area relevant to First Nations People.At the time of writing, VAD is operating in all states. 86Reports of some states' VAD regulatory Boards indicate that people who identify as Aboriginal and/or Torres Strait Islander have applied to access VAD. 87s with the general Australian population, there are diverse attitudes and beliefs regarding VAD among First Nations People.For all people, personal values and beliefs, including cultural, spiritual and religious beliefs, guide decision-making at the end-of-life, 88 including decisions about accessing VAD. 89While a person may involve family and others in discussions about VAD, each state's laws require the decision to access VAD to be made autonomously and voluntarily by the person, and only if they have decision-making capacity. 90An Indigenous person's family or community cannot choose VAD for a person. 91Where required, interpreters can provide communication support to assist a person to access VAD. 92

Online training module
The online training module Aboriginal and/or Torres Strait Islander Peoples and end of life law was launched in September 2022 as part of the ELLC training program. 93It is self-directed, interactive and includes case studies.
In addition to legal analysis, consultation was undertaken with Aboriginal and Torres Strait Islander palliative care and health professional stakeholders to inform the module.The consultation included participation in a National Yarning Circle comprising representatives from key Indigenous health professional bodies.These stakeholders provided invaluable knowledge, stories and perspectives about endof-life and palliative care to support identification of relevant cultural, health and legal considerations.Non-Indigenous health professionals with experience caring for Indigenous people were also consulted.
All stakeholders shared perspectives on the challenges that First Nations People may experience in end-of-life decision-making, and stories of decision-making involving Indigenous patients, families and community.Three Indigenous professionals with expertise in nursing, health and palliative care (including co-author Eliza Munro) were integral in identifying these challenges and concerns, providing knowledge, facilitating connections with Indigenous stakeholders, guiding module development, and undertaking review.
An Aboriginal artist worked with a graphic designer to design a unique logo and artwork for the module (Figures 1,  2 and 3).The artwork demonstrates the importance of cultural law and Lore in the Indigenous setting.It depicts the flow of information through community back and forth to understand practices and protocols, and how they relate to mainstream non-Indigenous law.
The module is novel in several respects.It examines significant historical, socio-economic, cultural, and health care considerations relating to Aboriginal and Torres Strait Islander peoples.This enables the cultural, historical and social context in which the law operates to be understood and acknowledged.Further, consultation with key Indigenous stakeholders enabled Aboriginal and Torres Strait Islander knowledge and perspectives to directly inform the development of accurate, relevant, Culturally Safe and Culturally Responsive module content, and realistic case studies based on actual experiences and clinical cases.Finally, the module comprehensively addresses Australian end-of-life decision-making laws relevant to the experiences of First Nations People.

Conclusion
End-of-life decision-making for many Aboriginal and Torres Strait Islander peoples can be shaped by diverse cultural values, beliefs and customs.Connection to Country, kinship, Lore, spirituality and religion may have a profound impact on treatment preferences.However, some Indigenous people continue to face significant barriers to accessing health care, arising from a range of historical, socio-economic and systemic factors, which can also impact end-of-life decision-making.
We undertook a novel analysis to determine the key legal considerations at end-of-life when caring for Aboriginal and Torres Strait Islander peoples.These processes highlighted consent to treatment, collective and substitute decision-making, and end-of-life treatment decisions including withholding and withdrawing life-sustaining treatment, provision of pain and symptom relief, as well as VAD, as key areas relevant to Indigenous people.
Two central themesthe importance of clear, honest and Culturally Safe and Respectful communication, together with the role of collective decision-making at the end-of-lifeemerged throughout the analysis.Effective communication and trusting relationships between health professionals and Indigenous people is critical to obtaining consent, capacity determination, treatment decision-making, resolving conflict and delivering end-of-life care that reflects the person's preferences and values.Some Indigenous people may prefer to make end-of-life decisions collectively, where decision-making occurs collaboratively with family and community.
This analysis has important implications for legal and health professionals, and for policymakers.For each of these groups, understanding the cultural, historical, social and health factors influencing end-of-life decision-making with First Nations People can support delivery of health and legal services and systems that are culturally aware, safe and responsive. 94This can also reduce existing barriers to accessing palliative and end-of-life care for many Indigenous people.We also suggest there may be value in education for Indigenous communities on the core themes and domains discussed in this article, to support enhanced knowledge and awareness of the law and legal rights at the end-of-life.

Acknowledgment
The authors acknowledge and pay their deepest respect to the past, present and future Traditional Custodians and Elders of the many lands on which we work and live, and the continuation of cultural, spiritual, and educational practices of Aboriginal and/or Torres Strait Islander peoples.The authors also respectfully acknowledge the cultural sensitivities surrounding Sorry Business, Sad News and Finishing Up.
The authors gratefully acknowledge the contribution of the many Indigenous health professionals and stakeholders across Australia, including the Palliative Care Australia Yarning Circle, who provided invaluable knowledge and perspectives to inform the training module.We also acknowledge the ELLC National Advisory Committee 2020-23 for their ongoing support and

Declaration of conflicting interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was undertaken as part of developing training for the End of Life Law for Clinicians (ELLC) project which is funded by the Australian government's Department of Health and Aged Care.The funder had no involvement in the preparation of the manuscript nor the decision to submit for publication.

3Langton,
Welcome to Country Handbook (n 1) 43. 4 For discussion of how cultural beliefs, communication styles, and family and community relationships can shape interactions with health professionals and systems, see Indigenous Program of Experience in the Palliative Care Approach, Cultural Considerations: Providing End-of-Life Care for Aboriginal Peoples and Torres Strait Islander Peoples (Guidelines, 2020) ('IPEPA Cultural Considerations').

25Queensland Health ,
Aboriginal and Torres Strait Islander Patient Care Guideline (May 2014) ('Qld Aboriginal and Torres Strait Islander Patient Care Guideline'); Victoria Department of Health, Victoria's End of Life and Palliative Care Framework (2016); Government of WA, Department of Health, Aboriginal End-of-Life and Palliative Care Framework (2021).

34
Livermore v The New Children's Hospital Westmead[2002] NSWADT 111, 24. Green and Dawn Bessarab, '"Yarn with me": Applying Clinical Yarning to Improve Clinician-Patient Communication in Aboriginal Health Care' (2016) 22(5) Australia Journal of Primary Health 377, 377.39 National Aboriginal and Torres Strait Islander Health Worker Association, The importance of Aboriginal and/or Torres Strait Islander Health Workers and Health Practitioners in Australia's health system (Statement, August 2019) 1. 40 Qld Aboriginal and Torres Strait Islander Patient Care Guideline (n 25).41 Pat McGrath et al, 'The case for Aboriginal Health Workers in palliative care' (2007) 3(3) Australian Health Review 430, 437.42 Lin, Green and Bessarab (n 38) 378.43 Simone Sherriff and Josephine D Gwynn, 'Yarning Together: Toward targeted, co-designed parenting programs for Aboriginal Australians' (2024) 220(6) Medical Journal of Australia 313, 313.

Figure 1 .
Figure 1.Diagram of considerations for medical treatment discussions with Indigenous people.
See Bronwyn Carlson et al, The Routledge Handbook of Australian Indigenous Peoples and Futures (Routledge, 2023).
Penny Neller  https://orcid.org/0000-0002-1762-1976Penny Neller is the Project Manager for the National Palliative Care Projects, Australian Centre for Health Law Research, at the Faculty of Business and Law, Queensland University of Technology.This author does not identify as being of Aboriginal and/or Torres Strait Islander origin.Rachel Feeney is a Postdoctoral Research Fellow in the Australian Centre for Health Law Research at the Faculty of Business and Law, Queensland University of Technology.This author does not identify as being of Aboriginal and/or Torres Strait Islander origin.Lindy Willmott is a Professor of Law in the Australian Centre for Health Law Research at the Faculty of Business and Law, Queensland University of Technology.This author does not identify as being of Aboriginal and/or Torres Strait Islander origin.Shih-Ning Then is a Professor of Law in the Australian Centre for Health Law Research at the Faculty of Business and Law, Queensland University of Technology.This author does not identify as being of Aboriginal and/or Torres Strait Islander origin.Eliza Munro is a Sorry Business Consultant with Ngiyani Wandabaa and was the Indigenous Project Coordinator, Gwandalan National Palliative Care Project.This author is a proud spiritual woman from the Gamilaroi Nation.Katie Cain is a Research Assistant in the Australian Centre for Health Law Research at the Faculty of Business and Law, Queensland University of Technology.This author does not identify as being of Aboriginal and/or Torres Strait Islander origin.Patsy Yates is a Distinguished Professor in the Faculty of Health and Office of the Executive Dean, Queensland University of Technology.This author does not identify as being of Aboriginal and/or Torres Strait Islander origin.Ben P White is a Professor in the Australian Centre for Health Law Research at the Faculty of Business and Law, Queensland University of Technology.This author does not identify as being of Aboriginal and/or Torres Strait Islander origin.