Living wills: where are we?
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