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

CHAPTER 1ORIGINS OF ADVANCE CARE DIRECTIVES,SCOPE OF REPORT AND GENERAL PRINCIPLESAIntroduction1.02 In this chapter the Commission describes the origins of advance caredirectives, the wider setting of the law on mental capacity within which theyarise and the general principles that have informed the Commission‘s approachto this area. In Part B, the Commission discusses the emergence of advancecare directives in the context of advances in health care and the move towardsinformed decision making. The Commission places this in the wider setting ofreform of the law on mental capacity envisaged in the Government‘s Scheme ofa Mental Capacity Bill 2008. The Commission also provides some examples ofadvance care directives to emphasise that they are not confined to the end-oflifesetting. In Part C, the Commission discusses the emergence of advancecare directives in the United States and the United Kingdom, largely associatedwith a number of high-profile court cases involving end-of-life treatment. Thegrowing emergence of relevant international instruments, in particular from theCouncil of Europe, is also discussed.1.03 The Commission then discusses the emergence of the debate onadvance care directives in Ireland, including relevant case law and theimportant work of bodies such as the Irish Council for Bioethics and the IrishHospice Foundation. The Commission concludes by recommending theintroduction of a legislative framework for advance care directives. Part Ddiscusses the scope of this <strong>Report</strong>, in particular that its focus is on refusals ofmedical treatment. This Part also points out that the Commission‘s proposals donot affect any action that is currently prohibited by the criminal law. Part E setsout the general rights and principles that form the basis for the Commission‘sdetailed proposals, derived from the discussion in Part C.BEmergence of advance care directives1.04 In this Part, the Commission discusses the emergence of advancecare directives. This begins with a discussion of advances in health care andmedical treatment and the movement from paternalism in medicine towards a7