Liv­ing wills: where are we?

The Irish Times - Tuesday - Health - - Family Preparing For Death -

Leg­is­la­tion has been in place in Ire­land for “liv­ing wills”, or what are called Ad­vanced Health­care Di­rec­tives (AHDs), since De­cem­ber 2015, but is yet to be im­ple­mented.

They will be cov­ered un­der the As­sisted De­ci­sion-Mak­ing (Ca­pac­ity) Act 2015, which the Ir­ish Hos­pice Foun­da­tion (IHF) de­scribes as “one of the most pro­gres­sive pieces of leg­is­la­tion in the West­ern World” on this is­sue.

“Our leg­is­la­tion sup­ports peo­ple to make an un­wise de­ci­sion,” says IHF de­vel­op­ment of­fi­cer Deirdre Shanagher. Un­like in the UK, it doesn’t have a pro­vi­sion for “best in­ter­est”, un­der which clin­i­cians can over-rule some­body’s per­sonal de­ci­sion on treat­ment op­tions.

How­ever a lot of steps have to be taken be­fore this leg­is­la­tion can be en­acted. Key to this, she ex­plains, is the ap­point­ment, be­lieved to be im­mi­nent, of a di­rec­tor of De­ci­sion Sup­port Ser­vices, which will be an in­de­pen­dent body.

It is en­vis­aged that an on­line reg­is­ter for AHDs will be es­tab­lished and this will need to be linked to the in­com­ing sys­tem of in­di­vid­ual health iden­ti­fiers for ev­ery­body us­ing the health ser­vice. Health­care pro­fes­sion­als would have to be able to ac­cess end-of-life in­for­ma­tion lodged by their pa­tient.

As the sit­u­a­tion stands, AHDs are le­gal un­der com­mon law, says Shanagher. “There were de­ci­sions made in court that sup­ported peo­ple hav­ing an Ad­vanced Health­care Di­rec­tive. What this leg­is­la­tion brings is a le­gal frame­work – it will pro­vide clear guid­ance for peo­ple mak­ing an AHD and for health­care pro­fes­sion­als.”

The time­frame for its full im­ple­men­ta­tion is im­pos­si­ble to pre­dict. In the mean­time, if peo­ple want to be proac­tive about ad­vanced health­care plan­ning, says Shanagher, there are forms avail­able. “Think Ahead”, avail­able on the IHF’s web­site, is one of those forms and it has an AHD in it “that is in keep­ing with the leg­is­la­tion as far we know at the mo­ment”.

The IHF also en­cour­ages peo­ple not to be afraid of start­ing con­ver­sa­tions about these mat­ters.

“If you feel strongly enough about your pref­er­ences at the end of life, it is im­por­tant you tell peo­ple,” she adds.

Con­ver­sa­tions about this and many other as­pects of death will be prompted at the “Your Life, Your Death, Your Say”, the Ir­ish Hos­pice Foun­da­tion’s bi-an­nual fo­rum in Dublin Cas­tle on Oc­to­ber 10th. In ad­di­tion to key­note speaker Prof Jenny Kitzinger, the for­mer Supreme Court judge, Mrs Jus­tice Cather­ine McGuin­ness, chair of the Na­tional Coun­cil of the Fo­rum on End of Life, will de­liver the Mary Hol­land Com­mem­o­ra­tive Lec­ture, en­ti­tled “The De­par­ture Lounge”.

More in­for­ma­tion and book­ings: hos­pice­foun­da­tion.ie

For­mer Supreme Court judge Cather­ine McGuin­ness, chair of the Na­tional Coun­cil of the Fo­rum on End of Life, will de­liver the Mary Hol­land Com­mem­o­ra­tive Lec­ture

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