Advance Healthcare Directives are important tools for individuals to express their healthcare wishes in case they become unable to make decisions for themselves.
These documents allow people to outline their preferences for medical treatments and interventions. This ensures their values and choices are respected even when they cannot communicate them directly.
In recent years, there have been significant updates to the laws and regulations surrounding Advance Healthcare Directives. These changes aim to provide clearer guidelines for both individuals creating directives and healthcare professionals implementing them.
Understanding the current requirements and processes for creating and using these documents is crucial for anyone considering their future healthcare options.
Key Takeaways
- Advance Healthcare Directives allow individuals to specify their future medical treatment preferences
- Recent legal changes have updated the guidelines for creating and implementing these directives
- Designated representatives play a vital role in ensuring a person’s healthcare wishes are followed
What is an Advance Care Plan?
An Advance Care Plan is a written document that outlines a person’s wishes for medical and surgical treatment in case they become unable to make decisions in the future. This document, also known as an Advance Healthcare Directive (AHD), serves as a guide for family members, carers, and healthcare professionals.
The plan comes into effect only when an individual loses the capacity to communicate their preferences. It may include decisions such as refusing resuscitation if one’s heart stops beating or declining the use of a ventilator to prolong life.
An Advance Care Plan helps ensure that a person receives care according to their specific wishes, even when they cannot express them directly. It also provides clarity to family members about the desired care.
It’s important to note that creating an Advance Care Plan is entirely voluntary. Individuals are not obligated to make one if they do not wish to do so.
Lasting Power of Attorney
As of April 2023, Ireland has made significant changes to its laws regarding powers of attorney. The Enduring Power of Attorney (EPA), as it was traditionally known, has been replaced by a new system under the Assisted Decision-Making (Capacity) Act 2015, which fully commenced in April 2023.
Under this new legislation, you can still create a type of power of attorney, but it is now referred to as a “Decision-Making Assistant Agreement” or “Co-Decision-Making Agreement”, depending on the level of support needed. These new structures are designed to ensure that individuals who might need assistance with decision-making can still retain autonomy, while also having support.
The new Decision Support Service (DSS) regulates these decision-making supports. The changes aim to modernise and align Ireland’s laws more closely with human rights obligations, ensuring that people’s rights and preferences are upheld.
If you want to create something similar to an EPA, you can now make a Decision-Making Agreement, and it is recommended to seek legal advice to ensure the correct form is completed under the new system.
However, if you created an EPA before April 2023, it remains valid under the new rules.
Changes to Advance Healthcare Directives in 2023
The Assisted Decision-Making (Capacity) Act 2015 brought important updates to healthcare planning in Ireland. From 26 April 2023, a new legal framework for Advance Healthcare Directives took effect.
This change gives stronger legal backing to these documents. The Decision Support Service was created to help put these new rules into practice. A code of practice now guides healthcare workers on using these directives.
The Role of the Appointed Healthcare Advocate
Who Can Serve as an Appointed Healthcare Advocate?
An individual must be at least 18 years old to take on this role. The chosen person should be willing to act on behalf of the patient. There are certain restrictions:
- Those convicted of offences against the patient or their child are ineligible
- Employees or owners of care facilities where the patient resides cannot serve (unless they are relatives)
- Paid carers or healthcare providers are excluded (except for relatives or primary carers)
What Are the Duties of an Appointed Healthcare Advocate?
The advocate’s primary responsibility is to ensure the patient’s wishes are followed. They:
- Interpret the patient’s healthcare preferences to medical professionals
- Make treatment decisions based on the advance healthcare directive
- Keep records of decisions made on the patient’s behalf
These actions only occur if the patient loses decision-making capacity. The advocate must document any decisions within 7 days. If the patient regains capacity, they receive copies of these records.
The Decision Support Service may also:
- Send representatives to speak with the patient or advocate
- Request copies of decision records
- Investigate complaints about the advocate’s actions
Advocates work closely with the healthcare team to ensure the patient’s wishes are respected. They may need to review the patient’s medical file to make informed decisions.
Key Responsibilities:
- Communicate patient preferences
- Make treatment choices
- Keep accurate records
- Cooperate with oversight
Advocates play a crucial role in preserving patient autonomy when individuals can no longer speak for themselves.
Are Advance Healthcare Directives Legally Enforceable?
Advance Healthcare Directives (AHDs) can be legally enforceable under specific circumstances. When an individual loses decision-making capacity, their AHD may become binding if it addresses the exact medical situation at hand.
For AHDs refusing certain treatments to be legally binding, they must meet these criteria:
- The person has lost decision-making capacity
- The proposed treatment matches the one specified in the AHD
- The circumstances align precisely with those outlined in the directive
It’s crucial to be clear and specific when drafting an AHD. If one wishes to refuse a treatment in some situations but not others, all circumstances must be detailed thoroughly.
For life-sustaining treatments, the AHD must explicitly state that it applies to such interventions. Without this clear statement, the directive may not be considered binding for these critical decisions.
Requests for specific treatments in an AHD are not legally binding. However, medical teams must take these preferences into account when making treatment decisions, provided they are relevant to the person’s current medical condition.
When an Advance Healthcare Directive May Be Disregarded
There are several situations where an AHD might not be followed:
- Mismatch of circumstances: If the current medical situation doesn’t precisely match the conditions outlined in the AHD, it may not apply.
- Contradictory actions: If the person, while still capable, acts in a way that contradicts their AHD (e.g., consenting to a previously refused treatment), the directive may be considered invalid.
- Illegal requests: Any instructions in an AHD that involve illegal actions cannot be carried out. For example, requests for assisted dying are not permissible.
- Unclear or ambiguous language: If the AHD is not clearly written or open to interpretation, healthcare providers may be unable to follow it confidently.
- Outdated information: If medical advancements have significantly changed the risks or outcomes of a treatment since the AHD was written, it may be deemed no longer applicable.
To ensure an AHD is legally binding, it’s advisable to consult with healthcare professionals and legal experts when drafting the document. Regular reviews and updates can also help maintain its relevance and enforceability.
Creating an Advance Healthcare Plan
An Advance Healthcare Plan allows individuals to express their preferences for future medical care. This document becomes crucial when someone can no longer make decisions about their treatment. Here’s how to create one:
- Age requirement: Must be 18 or older
- Timing: Can be made at any point in adulthood
- Cost: Free to create, modify, or cancel
- Write the plan
- Sign it with two witnesses present
- Get signature from Designated Healthcare Representative (if applicable)
It’s wise to inform close family and friends about the plan. Providing copies to GPs and other relevant healthcare professionals is also recommended.
Healthcare professionals are required to check for an Advance Healthcare Plan if a patient lacks decision-making capacity.
Modifying or Cancelling the Plan
Individuals can change or end their Advance Healthcare Plan at no cost, provided they have the mental capacity to do so.
To cancel the plan:
- Put the decision in writing
To modify the plan:
- Document changes in writing
- Sign in front of two witnesses
- Obtain signature from Designated Healthcare Representative (if applicable)
Regular reviews of the plan are advised, especially after major medical events or diagnoses. This ensures the document accurately reflects current wishes and medical history.
Organisations offering assistance
Several groups in Ireland provide support for advance healthcare planning. The Irish Hospice Foundation runs Think Ahead, a programme helping people consider and document their preferences for emergencies, serious illnesses, or death.
Think Ahead offers a planning pack with an Advance Healthcare Directive template, available to download or order from their website.
The Decision Support Service (DSS) works to protect the rights of those who may need help making decisions. They can investigate complaints about appointed healthcare representatives. The DSS website has helpful information on Advance Healthcare Directives.
Resources:
- Think Ahead Planning Pack
- Template Advance Healthcare Directive form
- DSS guidance on healthcare planning
These tools can help people plan for future healthcare needs and ensure their wishes are known if they become unable to communicate them.
Common Queries about Advance Healthcare Directives
What makes an advance healthcare directive legally binding in Ireland?
An advance healthcare directive becomes legally valid in Ireland when it meets specific criteria. The person creating it must be at least 18 years old and have decision-making capacity. The directive needs to be in writing, signed, and dated. It should clearly state the person’s wishes for future healthcare decisions if they become unable to make those choices themselves.
How can one create a clear and unambiguous advance healthcare directive?
To create a clear directive, one should:
- Use simple, straightforward language
- Be specific about medical treatments
- Update the document regularly
- Discuss wishes with family and doctors
- Consider getting legal advice
It’s crucial to avoid vague statements that could lead to misinterpretation.
What key elements should a comprehensive advance healthcare directive template include?
A robust template should contain:
- Personal details
- Medical conditions
- Specific treatment preferences
- End-of-life care wishes
- Designated healthcare representative
- Signatures and dates
- Witness information
How do contents and witnessing affect an advance healthcare directive’s validity?
The contents must be clear and consistent with current laws. Ambiguous language can make the directive difficult to follow. Proper witnessing is crucial.
Typically, two adult witnesses are required. They cannot be family members or potential beneficiaries of the person’s estate.
Under what conditions might a do-not-resuscitate order be deemed lawful in Ireland?
A do-not-resuscitate (DNR) order may be considered legal if:
- It’s part of a valid advance healthcare directive
- The patient has decision-making capacity when creating it
- It’s clearly documented in medical records
- Healthcare professionals are aware of its existence
What are the steps for making an advance decision regarding healthcare?
To make an advance healthcare decision:
- Consider personal values and preferences
- Discuss with family and healthcare providers
- Research treatment options
- Draft the directive
- Review and update regularly
- Inform relevant parties
- Store the document in an accessible place
