Assisted Decision Making - Key information on the Act

The Assisted Decision-Making (Capacity) Act was signed into law on 31 December 2015. Progress on the Bill will resume in the Houses of the Oireachtas as early as possible following the beginning of the autumn session, and it remains the intention and firm commitment of Government to commence the 2015 Act in full as soon as possible.  The Act recognises that, as far as possible, all adults have the right to play an active role in decisions that affect them. These decisions can be about their personal welfare and property and affairs.

The Act provides for the reform of the law relating to persons who require or may require assistance in exercising their decision-making capacity, whether immediately or in the future. The Act applies to everyone over 18 and will have wide-ranging implications for all health and social care providers. 

Among other reforms, the 2015 Act created a tiered system of decision support arrangements for people who need help with making decisions, abolishes the current wardship system and establishes the Decision Support Service .

This new Act will assist in complying with human-rights obligations contained in the Constitution of Ireland, the European Convention on Human Rights, and the United Nations Convention on the Rights of Persons with Disabilities. 

What impact does this have?

The reforms and benefits provided in the Act will require changes for staff and services to ensure successful implementation of these welcome reforms and to adequately deliver on the intended benefits. 

The Act compels staff to presume decision-making capacity as a starting position and to exhaust all possibilities to enable a person to make a decision. It requires staff to gain consent from the person or from those who have legal authority to act for the person. 

The guiding principles of the Act require healthcare workers to do the following: 

  • Presume every person has the capacity to make decisions about their life.
  • Support people as much as possible to make their own decisions.
  • Don’t assume a person lacks capacity just because they are making, have made or are likely to make an unwise decision.
  • Only take action where it is really necessary.
  • Any action should be the least restriction on a person’s rights and freedoms.
  • Give effect to the person’s will and preferences.
  • Consider the views of other people.
  • Consider how urgent the action is.
  • Use information appropriately.
  • Interact with decision supporters.

Interacting with Decision Supporters

Healthcare workers

Healthcare workers will be required to engage with a person’s legally appointed decision supporter under the 2015 Act. Healthcare workers may also be required to check a national register to see if a person has a decision supporter and/or to check that the decision supporter is working within the scope of the agreement.

All practicable steps to support decision-making

If a person needs to make a decision in relation to their care or treatment, they must be supported to make that decision, e.g. through the provision of accessible information. This will mean that health and social care consultations may take more time.

Functional assessment of decision-making capacity

The functional assessment of capacity will now have a statutory basis and should be used in place of status based capacity assessments for the assessment of decision making capacity. Healthcare professionals and registered medical practitioners may be  required to undertake assessments of capacity under some sections of the Act e.g. to assess whether a person can make decisions with the support of a co-decision maker or has the capacity to make an Enduring Power of Attorney.

Advance Healthcare Directive

The purpose of an Advance Healthcare Directive (AHD) is to provide healthcare professionals with important information about a person’s refusal of healthcare treatment and to enable a person to be treated according to his or her own ‘will and preferences’ even when he or she no longer has the capacity to make decisions.

Read more information about how to best support people using HSE services who have an AHD.

Read more about the Decision Support Service on Advance Healthcare Directives

What can I do to prepare?

The Act brings about important changes for people who require support to make decisions and for anyone interacting with them, including healthcare workers. It is your responsibility to understand the reforms that will be enacted following the commencement of the Act.

To help prepare you, the National Office for Human Rights and Equality Policy have developed the numerous educational and support resources. Please take some time to familiarise yourself with the Act by joining future webinars, participating in e-Learning courses, reading the Frequently Asked Questions, or browsing the other content on this website.

The Decision Support Service has put together a detailed list of considerations and resources. Things you will want to consider as you prepare for the commencement of the Act include:

  • Developing a support arrangement with someone you trust
  • Thinking about your property and affairs
  • Planning for your personal welfare

More information and additional details on these topics is available on Decision Support Service

About this Webpage & Quick Links

This webpage is from theHSE National Office for Human Rights and Equality Policy Team. It aims to present information and resources relevant to the Assisted Decision Making (Capacity) Act 2015 to help healthcare workers implement the Act in their work.

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