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

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(ii) the name and address of that person‘s general practitioneror other health care professional, and(iii) the name and address of the health care proxy (if any).(c) A written advance care directive that involves a refusal of lifesustainingtreatment person shall be witnessed by at least one person.(5) A refusal of treatment (other than one that involves a refusal of lifesustainingtreatment) constitutes a valid advance care directive where —(a) it is recorded on a person‘s medical charts or notes, or(b) it is contained in a clear written statement such as the cardcommonly known as a ―no blood‖ card.(6) Where, following an appropriate process of consultation, any term ofan advance care directive is ambiguous, any such doubt shall be resolved infavour of the preservation of life.(7) A person may verbally revoke an advance care directive at any timewhether the advance care directive was made in written or unwritten form.(8) The length of time between the making of an advance care directiveand its activation does not affect its validity or applicability, but a health careprofessional may have regard to the length of time in determining itsapplicability to the specified treatment.Explanatory NoteSubsection (1) implements the recommendations in: paragraph 3.77 concerningthe general conditions for the validity of an advance care directive; and inparagraph 3.70 concerning informed decision-making. Subsection (2)implements the recommendations in paragraph 3.86 concerning the generalconditions for the applicability of an advance care directive. Subsection (3)implements the recommendation in paragraph 3.09 that an advance caredirective shall not involve the refusal of basic care. Subsection (4)(a)implements the recommendation in paragraph 3.48 that an advance caredirective involving a refusal of life-sustaining medical treatment must be inwriting. Subsection (4)(b) implements the recommendation in paragraph 3.49that such a written advance care directive need not be in a prescribed form butmust contain certain specified information at least. Subsection (4)(c)implements the recommendation in paragraph 3.59 requiring that any advancecare directive involving the refusal of life-sustaining treatment must be117
witnessed. Subsection (5) implements the recommendation in paragraph 3.50concerning the validity of advance care directives recorded on medical recordsor in clear written forms such as ―no blood‖ cards. Subsection (6) implementsthe recommendations in paragraphs 1.106 and 3.86 concerning a presumptionin favour of preserving life in the event of any ambiguity in an advance caredirective. Subsection (7) implements the recommendation in paragraph 3.89that an advance care directive, whether unwritten or written, may be revokedverbally. This is consistent with the Council of Europe‘s 2009 DraftRecommendation on Principles Concerning Continuing Powers of Attorney andAdvance Directives for Incapacity. Subsection (8) implements therecommendation in paragraph 3.93 concerning lapse of time between makingan advance care directive and its activation.Health care proxy6.— (1) A health care proxy may be appointed under an advance care directive.(2) The maker of an advance care directive may confer on a health careproxy powers limited to —(a) ensuring that the terms of the advance care directive are carried out,and(b) consulting with a health care professional in the event that there isambiguity in any provision of the advance care directive.(3) (a) The maker of an advance care directive may confer on a healthcare proxy a general power to refuse health care treatment, with theexception of refusal of life-sustaining treatment.(b) (i) The maker of an advance care directive may confer on a healthcare proxy a specific power to refuse health care treatment, includingrefusal of life-sustaining treatment.(ii) Where the maker of an advance care directive confers on a healthcare proxy a specific power to refuse life-sustaining treatment, theadvance care directive shall be witnessed.(4) (a) An advance care directive that includes the appointment of ahealth care proxy need not be in writing.118
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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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dentist 3psychologist 4social care
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should be defined to include, but i
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chemotherapy or dialysis, antibioti
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Similarly, Power argues that there
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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 and 120: directive would be likely to be enf
Page 121 and 122: Ensuring that the wishes of the mak
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 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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