Advance Healthcare Directives
An Advance Healthcare Directive is a statement you can make on the type of medical or surgical treatment you want or do not want, if you are unable to make these decisions in the future. It only comes into force if you lose capacity and you can no longer communicate your decisions yourself.
An Advance Healthcare Directive provides direction to healthcare professionals to care for you according to your specified wishes, and clarity to families about the care you requested.
The Assisted Decision-Making (Capacity) Act 2015 sets out a system of supports for adults who have difficulties with decision-making capacity. A legal framework for Advance Healthcare Directives in Ireland is also set out in the Act, but this has not yet been commenced (not yet in operation).
As part of the Act, the Decision Support Service will be set up to support people who need help with decision making. This is expected to be operational in mid-2022.
This document describes the situation that applies until these laws come into operation.
If you are not capable of making your own decisions, you can also grant power to make decisions to someone else on your behalf by creating an Enduring Power of Attorney. However, an Enduring Power of Attorney does not give anyone else a legal right to make decisions about your healthcare.
What is an Advance Healthcare Directive?
An Advance Healthcare Directive is a written statement about the medical or surgical treatment you want in the future if you will not be able to make that decision at the relevant time. For example, you may not want to be resuscitated if your heart stops beating, or you may not want to be kept alive with the use of a ventilator. It is sometimes known as a living will, advance statement, advance decision or advance refusal.
An Advance Healthcare Directive is a legal document and you have to sign your directive in the presence of 2 witnesses.
It lets your family, carers and health professionals know your wishes about your medical and surgical treatment if you're unable to make or communicate those decisions yourself.
You may want to refuse a treatment in some situations, but not others. If this is the case, you need to be clear about all the circumstances in which you want to refuse this treatment. You should update your directive if you change your mind and you can also revoke (cancel) a directive at any time, either verbally or in writing.
What is the legal status of Advance Healthcare Directives in Ireland?
The Assisted Decision-Making (Capacity) Act 2015 provides a legal framework for Advance Healthcare Directives in Ireland, but this part of the Act has not yet been commenced (not yet in operation). However, Advance Healthcare Directives are currently recognised in common law in Ireland.
Are Advance Healthcare Directives legally binding?
An Advance Healthcare Directive is a legally binding document where you write down what healthcare treatments you do not want in the future. For example, some people make a directive to limit the treatment given in order not to prolong life, such as a Do Not Resuscitate Order.
You can write what treatments you would like to receive too, but that is not legally binding. However, the treatment you name in your statement must be taken into consideration if it is relevant to your medical condition.
If your statement does not address the exact circumstances you face, it may not be enforced.
An Advance Healthcare Directive cannot be enforced if it specifies doing something which is illegal. For example, stating that you want to be given medication which will lead to your death. Deciding to refuse a treatment is not the same as asking someone to end your life or help you end your life.
As part of the directive, you can nominate a ‘designated healthcare representative’ who will be legally recognised as acting on your behalf if you lose capacity and can ensure your Advance Healthcare Directive is enforced.
You are not required to make an Advance Healthcare Directive.
Suicide and Assisted Suicide
You are entitled to refuse medical treatment if you have full mental capacity. But you cannot take positive measures to end your own life or another person's life.
The Criminal Law (Suicide) Act 1993 sets out the law on suicide. Suicide itself or an attempt to die by suicide is not a crime. However, it is a criminal offence to help another person to take measures to end their life.
It is a criminal offence to aid, help, encourage or procure the suicide of another person. This crime is usually called assisted suicide. The maximum penalty for assisted suicide is 14 years imprisonment. If you help someone to die by suicide, you may be charged with murder, manslaughter or assisted suicide depending on the circumstances. You could be charged if you help another person to end their life, even if the other person is terminally ill or wants to end their life.
This applies to medical professionals in the same way as to other people. However, pain killing drugs which may also shorten life may be given if the intention is to deal with pain and not to end life.
Think Ahead is part of an initiative by the Irish Hospice Foundation. Think Ahead aims to help people think about, discuss and record what their preferences are in the event of emergency, serious illness or death.
You can download the Think Ahead Form (pdf) to help guide you through this process.