Report on Bioethics: Advance Care Directives - Law Reform ...

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The making of the advance care directive was the voluntary act of theauthor, andThe maker has not communicated alteration or withdrawal of therefusal of treatment contained in the advance care directive.[paragraph 3.77]5.29 The Commission recommends that an advance care directive will beapplicable ifThe treatment is the treatment specified in the advance care directiveAll the circumstances outlined are presentWhile competent, the author of the advance care directive said or didnothing which puts reasonable doubt in the mind of the health careprofessional that the author had changed their mind but did not havethe opportunity to revoke the advance care directive.If the advance care directive is ambiguous, there will be a presumptionin favour of the preservation of life. [paragraph 3.86]5.30 The Commission recommends that the High Court be empowered todetermine whether an advance care directive exists, whether it is valid andwhether it is applicable to the relevant treatment under consideration.[paragraph 3.87]5.31 The Commission recommends that a competent person can verballyrevoke their advance care directive regardless of whether there is a verbal orwritten advance care directive. [paragraph 3.89]5.32 The Commission recommends that the proposed Code of Practice onAdvance Care Directives should recommend that advance care directives arereviewed regularly, but that there should be no specific time limit put on thevalidity of advance care directives. The Commission also recommends,however, that a health care professional may take into consideration the lapseof time between the making of an advance care directive and its activation.[paragraph 3.93]5.33 The Commission recommends the establishment of a register ofadvance care directives, especially those which must be in writing under theproposed statutory framework, and that suitable guidance on its developmentcould be given in the proposed Code of Practice on Advance Care Directives.[paragraph 3.96]5.34 The Commission recommends that the maker of an advance caredirective can confer a limited power on the maker of an advance care directivewhich can be105
Ensuring that the wishes of the maker of the advance care directive arecarried outConsultation with a health care professional if there is ambiguity in theadvance care directive [paragraph 3.104]5.35 The Commission recommends that the maker of an advance caredirective can confer a general power to refuse health care decisions on a healthcare proxy, except life-sustaining treatment.[paragraph 3.105]5.36 The Commission recommends a health care proxy will not have thepower to refuse life-sustaining treatment unless the advance care directiveexplicitly states that the health care proxy has such a power.[paragraph 3.106]5.37 The Commission recommends the proposed Code of Practice onAdvance Care Directives should include guidance on resolving any disputesbetween a healthcare proxy and a health care professional.[paragraph 3.107]5.38 The Commission recommends that an advance care directive thatincludes the appointment of a proxy may be unwritten or written. [paragraph3.111]5.39 The Commission recommends that the maker of an advance caredirective must explicitly state in a written advance care directive that they aregranting the health care proxy the power to refuse artificial life-sustainingtreatment and outline the scope of that power. [paragraph 3.112]5.40 The Commission recommends that a written advance care directiveappointing a proxy must containName of the proxyAddress of the proxy [paragraph 3.113]5.41 The Commission recommends that the maker of the advance caredirective and the proxy should be encouraged to discuss the advance caredirective. [paragraph 3.115]5.42 The Commission recommends that a Code of Practice on AdvanceCare Directives should be prepared under the proposed statutory framework toprovide guidance on the creation and execution of advance care directives. TheCommission also recommends that the Code of Practice should be prepared bythe proposed Office of Public Guardian and should be based on therecommendations of a multi-disciplinary Working Group established for thispurpose by the Office of Public Guardian with input sought from, for example,the Health Service Executive, the Medical Council, An Bord Altranais, patients‘groups, the Irish Hospice Foundation and HIQA. [paragraph 3.120]106
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ReportBIOETHICS:AD
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LAW REFORM COMMISSION‘S ROLEThe L
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LAW REFORM RESEARCH STAFFDirector o
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CONTACT DETAILSFurther information
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TABLE OF CONTENTSTable of Legislati
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CHAPTER 4CONSEQUENCES OF ESTABLISHI
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TABLE OF CASESAiredale NHS Trust v
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advance care directives in the Unit
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CHAPTER 1ORIGINS OF ADVANCE CARE DI
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1.08 The second major development i
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Refusal of treatments by pregnant w
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we believe Karen‘s choice, if she
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1995 English Law Commission <strong
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a declaration that it would be lawf
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Disabilities. 42 The draft Recommen
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(5) The development of advance care
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1.45 In the Supreme Court, Hamilton
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when determining the capacity quest
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(d)Current use of advance care dire
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e upheld. Indeed, this conclusion f
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services, the need for palliative c
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ecommendations in this Repo
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efusal of medical treatment, subjec
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consents to or refuses medical trea
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(2) Autonomy, dignity and privacy(a
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(3) Presumption in favour of preser
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2CHAPTER 2ADVANCE CARE DIRECTIVES,
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2.07 The Commission recommends that
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2.12 The Council of Europe‘s 2009
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donor understands the effect of mak
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should be referred to the High Cour
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2.30 Another protection of importan
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Page 73 and 74: should be defined to include, but i
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Page 77 and 78: Similarly, Power argues that there
Page 79 and 80: assist either health care professio
Page 81 and 82: approach met with broad approval an
Page 83 and 84: Practice on Advance Care Directives
Page 85 and 86: 3.48 The Commission recommends that
Page 87 and 88: (other than charges and directions
Page 89 and 90: 3.64 The Commission concurs with th
Page 91 and 92: advance care directive involves a r
Page 93 and 94: eyond question that a court or a do
Page 95 and 96: close relationship that can exist b
Page 99 and 100: care directive. 105 The Commission
Page 101 and 102: the wishes or making their own deci
Page 103 and 104: sustaining treatment or whether the
Page 105 and 106: (b) for the guidance of persons, in
Page 107 and 108: omission.‖ 5 The Supreme Court in
Page 109 and 110: who acted in good faith could be pr
Page 111 and 112: or health professional cannot, for
Page 113 and 114: follow an advance care directive is
Page 115 and 116: the Board can erase the name of a n
Page 119: directive would be likely to be enf
Page 124 and 125: APPENDIX DRAFT MENTAL CAPACITY (ADV
Page 126 and 127: Mental Health Act 2001Powers of Att
Page 128 and 129: ―basic care‖ includes, but is n
Page 130 and 131: (3) The scope of an advance care di
Page 132 and 133: (ii) the name and address of that p
Page 134 and 135: (b) Without prejudice to section 5(
Page 136 and 137: paragraph 3.13 (palliative care), p
Page 138 and 139: Subsection (2) implements the recom
Page 140 and 141: www.lawreform.ie
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