Advance Healthcare Directives

Assisted Decision Making 1

Part 8 of the Act provides a legislative framework in Ireland confirming the validity of Advance Healthcare Directives (AHD). Under these provisions, a person aged 18 and over who has capacity can make an Advance Healthcare Directive. There is no obligation on any person to make an Advance Healthcare Directive. The person making the directive can refuse medical treatment in advance provided the conditions set out in the Act are satisfied. This Part of the Act does not affect current law in relation to euthanasia or assisted suicide both of which are and continue to be illegal in Ireland.

In particular Part 8 of the Act provides for the following:

  • A person must put their decisions on future medical treatment in writing and their Advance Healthcare Directive must be witnessed.
  • A person will be able to revoke an Advance Healthcare Directive at any time – verbally or in writing.
  • No-one will be under any obligation to create an Advance Healthcare Directive – people are free to make them but are not required to do so.
  • Having witnesses to the Advance Healthcare Directive is a safeguard to prevent people being forced to make certain decisions.
  • A person can nominate a ‘designated healthcare representative’ who will be legally recognised as acting on the person’s behalf at a time when he or she loses capacity and can ensure the Advance Healthcare Directive is enforced. The designated healthcare representative may also be given a general power to consent to and to refuse treatment up to and including the refusal of life-sustaining treatment.
  • An Advance Healthcare Directive only comes into force when a person loses capacity and cannot make a decision.
  • An Advance Healthcare Directive provides direction to healthcare professionals to care for a person in accordance with their specified wishes.
  • An Advance Healthcare Directive provides clarity to families regarding the care requested by their relative.
  • In instances of serious doubt about an Advance Healthcare Directive, the Act provides for recourse to the Courts.
  • An Advance Healthcare Directive is a method of obtaining consent for treatment in advance.

 Advance Healthcare Directives Multidisciplinary Working Group

The HSE Assisted Decision Making (ADM) Steering Group has been invited by the Minister for Health, Simon Harris, T.D., to act as the Advance Healthcare Directive Multidisciplinary Working Group under the Act. The role of the group, as directed by the Minister for Health, will be to prepare a detailed series of recommendations for the Director of the Decision Support Service in relation to the interpretation and operation of the AHD provisions contained in the Act.

The role of the Working Group is as follows:

  • Provide advice and support on the development of the recommendations for the code of practice on Advance Healthcare Directives in accordance with the requirements of the Act
  • Provide advice and guidance on the development of Advance Healthcare Directives education and training implementation plan
  • Provide advice and guidance on the development of Advance Healthcare Directives information and communications plan
  • Consult with key stakeholders through a targeted consultation process on the draft recommendations for the codes of practice for Advance Healthcare Directivess
  • Review and incorporate feedback from the targeted consultation process as appropriate.
  • Liaise with other key stakeholders leading the development of ADM Codes of Practice e.g. Department of Justice, Department of Health, Mental Health Commission, National Disability Authority
  • Finalise and approve the draft recommendations for the code of practice for Advance Healthcare Directives and finalise and approve supporting documentation.
  • Submit to the Director of the Decision Support Service for consideration.

Consultation on the draft Codes of Practice took place in April 2017. You can view the consultation page here.

The draft Codes of Practice were updated following the conclusion of the consultation, and they have now been submitted to the Director of the Decision Support Service for consideration. 

For more information, please contact Marie Tighe, Project Manager, HSE National Quality Improvement Team at marie.tighe1@hse.ie