Questions and answers on Advance Healthcare Directives
What is an Advance Healthcare Directive?
It informs family, friends and doctors of your wishes for your treatment in the event you can no longer communicate them yourself.
It’s a legally binding document where you write down what healthcare treatments you wouldn’t like in the future.
You can write what treatments you would like to receive too but that is not legally binding. Health professionals are obliged to explain why they did not follow your preferences though
It relates specifically to your health care and your wishes with regard to your personal health.
For example if a person did not want to be resuscitated in the event their heart stopped beating, or they did not want to be kept alive by a ventilator they could state that in the document. It is important to be specific about the circumstances in which you wish to refuse treatment and to make sure that you update your directive if you change your mind. You can also verbally revoke a directive at any time
Is that not euthanasia or assisted suicide?
Absolutely not. Euthanasia and assisted suicide are both illegal in Ireland. A patient has the legal right to consent or refuse treatment even if their doctors strongly disagree with their decision
Is there an official Advanced Healthcare Directive form?
The Irish Hospice Foundation’s Think Ahead form allows you to specifically document an Advance Healthcare Directive.
But you can write your Advance Healthcare Directive on any piece of paper and as long as it is signed, dated and witnessed by two people it is valid. Both witnesses need to be over 18 and at least one of them must not be a member of your family and preferably should not be your attorney or your designated healthcare representative. If you don’t want to write it down you can make a voice or video recording of your Advanced Healthcare Directive.
Does it cost any money to get one?
The Irish Hospice Foundation’s Think Ahead form is available for free on-line at http://www.thinkahead.ie/ Hard copies are also available from The Irish Hospice Foundation – contact 01 6793188 for more details.. Some people may like to discuss their options with their GP but that this is not necessary. There is also no need to consult a solicitor. But if you would like to you will incur solicitor fees.
When should I make an Advance Healthcare Directive?
An Advance Healthcare Directive is recommended no matter what your age. However, you don’t have to fill one out. It is not mandatory.
What’s the benefit?
It means there is no decision making burden placed on family members if your healthcare wishes and preferences are known to them. In the absence of your directive end-of-life decisions will be made by your healthcare team. However a directive makes it easier for healthcare professionals too because they know what a person’s wishes and preferences are in different healthcare situations that might arise.
If you have been diagnosed with an illness having an advance healthcare directive will give you peace of mind and help you to focus on living well. Planning for end-of-life care in advance gives people and their families’ peace of mind during their final days, according to research.
Where do I keep it?
There will eventually be an Office of Decision Support Services and a record of valid Advanced Healthcare Directives will be kept there. Until that office is set up it is recommended that you tell the people that are likely to be there at the time of an emergency. Your GP is one option. But If you are keeping the document at home you should tell family members or friends where it is.
How would my GP or hospital staff know it exists? Who would be responsible for bringing it to their attention?
You are ultimately relying on family and friends to tell healthcare professionals about the directive if they are unware of it until a registry is established in the Office of Decision Support Services. Some people sometimes carry their directive with them
Can’t you already tell healthcare professionals how you want to be treated?
Yes, you can and you will. The Advance Healthcare Directive only comes into play if you lose decision making capacity and issues you have outlined in the document arise. Up until that point your healthcare professional will presume you have decision making capacity.
What is the legislation behind this called?
The Assisted Decision-Making (Capacity) Act 2015. It has been enacted and is on the Statute Books but hasn’t been commenced.
What does the legislation mean?
It’s a really important step for Ireland in promoting human rights. It was a necessary step for Ireland to take in ratifying the United Nations Convention of the Rights of Persons with Disabilities in 2006. It supports the autonomy of all people regardless of any disability. So it enables people with disability to be treated the same as a person who doesn’t have any disability.
The Constitution of Ireland also indicates the rights of bodily integrity and promotes the autonomy of people.
Are Advance Healthcare Directives legal if the Act hasn’t been commenced?
Yes. Court rulings have ‘upheld’ a person’s right to decide what they wouldn’t want in their end-of-life (health)care.
What this legislation brings is a framework to underpin that. It provides the structures to support the operation of Advance Healthcare Directives which are already legally binding.