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Healthcare Decisions

Advance Healthcare Directive (AHD)

An Advance Healthcare Directive (AHD) informs family, friends and healthcare workers of your wishes for your treatment in the event you can no longer communicate them yourself. It is a legally binding document where you record what healthcare treatments you would NOT like in the future and the circumstances for refusing them.

An AHD relates specifically to your healthcare, it is NOT a will or an enduring power of attorney.

If you are planning ahead, you can make an AHD. It allows you to:

  • set out your wishes now about medical and healthcare treatments in case you’re unable to make these decisions in the future.
  • record any treatment you do NOT wish to have and the circumstances for them e.g. if I have terminal cancer, I do not wish to have chemotherapy.

We strongly advise you discuss your AHD with your healthcare team who can guide you in making these decisions.

You can write the treatments you would like to receive too. Treatments you would like to receive are not legally binding, but healthcare workers are obliged to explain why they did not follow your preferences.

Below is an explainer video on the Assisted Decision-Making (Capacity) Act 2015 which was launched in September 2020 by the HSE.

Choosing Someone to Act on Your Behalf

Because of accident or illness and at any time in our lives, we could lose our ability to decide about our health care or medical treatment. When this happens, these decisions will need to be made by someone else. We can decide now who we would like to make these decisions for us. In an Advanced Healthcare Directive (AHD), this person is called a Designated Healthcare Representative.

Designated Healthcare Representative

Q. What is a Designated Healthcare Representative (DHR)?

A. A Designated Healthcare Representative is a person who makes a health care or medical treatment decision for a person who has lost decision-making capacity.

To put it simply when you nominate someone to speak on your behalf they ’use the voice’ of the person to make the decision. Generally the DHR decision has the same legal effect as if the person had capacity and had made the decision themselves.

A DHR will not need to make the decision if the person without capacity has recorded their wishes in a valid Advance Care Directive. The Directive will ‘tell’ your decision maker what you want and do not want to happen.

Q. What decisions can a DHR make?

A. A DHR can make most health care or medical treatment decisions for a person who has lost capacity. These decisions can include whether life-sustaining treatment should be provided or withdrawn.

Q. What should a DHR consider when making a decision?

A. If you have been given the privilege to speak on someone’s behalf you need to consult their Think Ahead document and Advance Healthcare Directive to inform you of the persons wishes. As you are stepping into their shoes consider what the person would have wanted if they had capacity.

For more information and guidance on being a Designated Healthcare Representative please visit

Get you Think Ahead form