Advance Healthcare Directives

You can make a written statement about the type of medical or surgical treatment you want or do not want, if in the future, you are unable to make these decisions. This is called an Advance Healthcare Directive (AHD).

An AHD is only used if you lose capacity and you can no longer communicate your wishes yourself. It lets your family, carers and healthcare professionals know your wishes about your medical and surgical treatment if you are unable to make or communicate those decisions yourself.

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 tells healthcare professionals how to care for you according to your specific wishes, when you can’t accurately tell them yourself. Advance Healthcare Directives also give clarity to your family about the care you wish for.

You do not have to make an Advance Healthcare Directive if you don’t want to.

Enduring power of attorney

You can also specify a person to make your decisions about your general welfare and property if you lose your capacity. This is done by creating an enduring power of attorney. However, an enduring power of attorney does not give that person a legal right to make decisions about your medical treatment.

The Assisted Decision-Making (Capacity) Act 2015 sets out a system of supports for adults who have difficulties with decision-making capacity. Advance Healthcare Directives were already recognised in Ireland but the Act establishes a legal framework for them since 26 April 2023.

As part of the Act, the Decision Support Service has been set up to support the introduction of these changes.

You can appoint someone you know and trust to act on your behalf if you lose the ability to make certain decisions. This person will be your Designated Healthcare Representative.

Based on the information in your Advance Healthcare Directive, they have the power to:

• Advise on and interpret your wishes, as set out in your AHD, to the healthcare professionals treating you
• Agree to, or refuse treatment on your behalf

They can only do this if you do not have the ability to make healthcare treatment decisions.

You can read the Code of Practice for the guidance of Designated Healthcare Representatives.

Who can be Designated Healthcare Representative?

You must choose a person that is willing to act on your behalf. They must be aged 18 or over.

The person cannot do the role if they:

• Have been convicted of an offence against your or your child
• Own, work in or are a registered provider of a designated centre or mental health facility where you live (unless they are your relative)
• Provide paid personal care or healthcare services to you (unless they are your relative or their primary carer)

What does a Designated Healthcare Representative do?

Your Designated Healthcare Representative must make a record of any decision made that relates to your Advance Healthcare Directive if you lose the capacity (ability) to make certain healthcare and treatment decisions. They have to do no later than 7 days after the decision is made.

Your Designated Healthcare Representative must provide a copy of this record to you if you later regain capacity. The Decision Support Service can also request a copy of this record.

The Decision Support Service can send someone to talk to you or your Designated Healthcare Representative. For example it can send out a general or special visitor if it receives a complaint about your Designated Healthcare Representative, or wants to check that the agreement is working the way that it should.

You can read about the different grounds for making a complaint about a Designated Healthcare Representative on the Decision Support Service website.

If you are refusing certain medical and surgical treatments, this can be legally binding if you lose capacity and the treatment proposed is the same as that set out in your AHD.

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 do not want this treatment.

The AHD may also not apply if you, after making the AHD and when you have capacity, do something contrary to the AHD, such as consenting to a form of treatment which you state in your AHD that you do not want.

If you want your ADH to apply to life-sustaining treatment, this must be clearly stated and in the ADH.

If you are requesting a future treatment you would like to receive in your Advance Healthcare Directive, it will not be legally binding on those treating you. However, the treatment you would like must be taken into consideration by the medical team treating you if the treatment is relevant to your medical condition.

When your Advance Healthcare Directive may not be followed

If your AHD does not apply to the exact circumstances you face, it may not be applied. For example, you may refuse amputation in certain circumstances. However, if you need an amputation in other circumstances not dealt with in your AHD, then the AHD may not apply.

If your AHD includes doing something which is illegal, it cannot be carried out. For example, if you write 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.

Advance Healthcare Directives are free to make, change and cancel. You can make one if you are aged 18 or over. You can make it at any time in your adult life and not just if you have received a diagnosis which may later affect your capacity.

When you make an Advance Healthcare Directive it must:

• Be made in writing
• Signed in the presence of 2 witnesses
• Signed by your Designated Healthcare Representative (if you have one – see below)

You can make an Advance Healthcare Directive yourself or you can use the Decision Support Service's Advance Healthcare Directive template form and guide (pdf).

It is recommended that you let the people closest to you know about your AHD and give a copy of it to your GP and any other healthcare professional who may be treating you. All healthcare professionals must check if you have an AHD if you lack the capacity to make a treatment decision.

How to change or end your Advance Healthcare Directive

You can cancel or end your Advance Healthcare Directive at any time, for free if you have the capacity to do so.

If you are ending your Advance Healthcare Directive, you have to do this in writing.

If you are changing your Advance Healthcare Directive, you have to:

• Do this in writing
• Sign it on front of 2 witnesses
• Get it signed by your Designated Healthcare Representative if you have one

You should review and, if necessary, update your AHD regularly so that it reflects your wishes, especially after any major medical treatment or diagnosis to make sure it reflects your medical history.

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 or order a Think Ahead Planning Pack on the Irish Hospice Foundation's website which includes a template Advance Healthcare Directive.

You can also find a template Advance Health Care Directive form on the Irish Hospice Foundation website.

The Decision Support Service (DSS) promote the rights and interests of people who may need support with decision-making. The DSS can review and investigate complaints about an appointed Designated Healthcare Representative. You can read the DSS information on Advance Healthcare Directives.