An Advanced Healthcare Directive
It is possible now under Irish law to put in place an Advance Healthcare Directive referred to here as an AHD. An AHD is a document that you sign now when you have legal capacity (that is when you are lucid and able to make decisions). The AHD sets out your wishes regarding your healthcare in the event that you do not have capacity to make decisions regarding your healthcare in the future. The AHD gives you a voice where you may not be able to communicate your wishes.
Why is an Advanced Healthcare Directive important?
Think back to the Covid 19 pandemic and the roll out of the vaccine. What was your attitude
to this? Which phrase would best match your line of thinking:-
“I really want the vaccine. It makes sense to me”
“If the health care experts say its okay, that’s good enough for me”,
“My neighbour is getting it and I don’t want to be left out”
“I am suspicious of this, I’m not sure”.
Regardless of your attitude or which of these responses match your personal preference, what each of the above response have in common is that they represent a very individual response to the taking of the vaccine. That is at the heart of what an AHD is about. Whether we obtain or refuse medication is a very personal decision. We make that decision on the basis of our beliefs, attitudes, biases and all the complexities that makes us who we are. A medical decision is very tied to who we are. Therefore, having medical decisions taken away from us, is a very serious limitation of who we are. That is why an AHD is important, because it allows us to remain ourselves even when we cannot communicate this.
That status of the law now
An Advance Healthcare Directive is now operating under the Assisted Decision Making (Capacity) Act 2015 (Part 8). We will deal with elements of that Act in this note below.
The Advance Healthcare Directive can be made by anyone over 18. It allows a person to appoint a “designated healthcare representative”, that is a person who will act on their behalf to assist with medical treatment in the event that the person loses capacity.
Contents of an AHD
The Advance Healthcare Directive must be in writing, by a person over 18, with legal capacity and signed by the directive maker.
The Advance Healthcare Directive normally has three elements:
The Advance Healthcare Directive normally has three elements:
1. Refusal of treatment requests.
2. Requests for specific treatment.
3. Dealing with end of life care.
1. Refusal of treatment requests.
It is possible to set out in an Advance Healthcare Directive that you do not wish to receive specific treatment if you lack capacity in the future. So for example “I do not wish to have radium treatment if I have liver cancer”. These refusal of treatment requests are binding on your medical team, but you must clearly identify the treatment that you wish to refuse, and also the ailment that it relates to.
2. Requests for specific treatment.
You can also specify in an Advance Healthcare Directive that you wish to have received specific treatment for particular ailments if you lack capacity in the future. For example, “I wish to use natural oils if I have skin cancer”. These statements are not legally binding but will be taken into consideration by your treating doctor in the context of your overall care.
3. Dealing with end of life care.
Advance Healthcare Directives then can deal with end of life care and circumstances regarding end of life.
So, if you are on artificial ventilation, or receiving artificial sustenance you can state whether or not you wish those procedures to be commenced or maintained in the event that you lack capacity. You can specify whether or not you wish to have artificial ventilation turned off so that you would die a natural death, or whether or not you wish those to be maintained even though you may have no prospect of recovery.
Your Advance Healthcare Directive can also deal with situations regarding cardiopulmonary resuscitation. This is also known as CPR. In some cases CPR may not be medically beneficial, but you may wish to request CPR to keep you alive and that is something that you can specify in your Advance Healthcare Directive.
Appointing a Health Care Proxy
The regime under the 2015 Act, also allows one to appoint someone who can advocate for you or represent our views. This person is known as an Designated Healthcare Representative. When writing out your advanced healthcare directive you can also appoint your representative and that representative will liaise with your medical team in setting forth your views. Your representative will normally be your spouse if you are married, but it can be any person you wish.