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

(5) The development of advance care directives in Ireland1.40 Developments in Ireland have followed a similar pattern as otherStates, with the first significant discussion of the issue being a lecture byCostello J in 1986 that addressed the US Quinlan case of 10 years previously.In 1996, the High Court and Supreme Court dealt with a high-profile caseinvolving a woman who had been in a near PVS state for over 20 years. Thedevelopment of a strong hospice movement in Ireland in recent years has alsoraised the profile of advance care planning at the end of life; and, in 2007 theIrish Council for Bioethics published an Opinion on Advance Care Directives. 47(a)Costello J’s 1986 lecture on the terminally ill1.41 In a lecture given in 1986 on the law concerning the terminally ill, 48Costello J noted that, in Re Quinlan, 49 the New Jersey Supreme Court hadconcluded that the withdrawal of artificial respiration from Karen Quinlan wouldnot amount to homicide on the basis that her death had not been as a result ofthe withdrawal of life-support but had resulted from natural causes. He alsosuggested that the right of the terminally ill patient to forego life-sustainingtreatment is compatible with the provisions of the Constitution of Ireland: 50―…there are very powerful arguments to suggest that the dignity andautonomy of the human person (as constitutionally predicated)require the State to recognise that decisions relating to life and deathare, generally speaking, ones in which a competent adult should befree to make without outside restraint, and that this freedom shouldbe regarded as an aspect of the right to privacy which should beprotected as a ‗personal‘ right by Article 40.3 [of the Constitution ofIreland]… [I]n the case of the terminally ill, it is very difficult to seewhat circumstances would justify the interference with a decision by acompetent adult of the right to forego or discontinue life-savingtreatment.‖1.42 These views, expressed by a leading Irish judge, even if writtenoutside his judicial role, strongly support the concept that an advance caredirective would be enforceable in Irish law. Indeed, they were also expresslyreferred to ten years later in a very similar Irish case.(b) The Ward of Court case (1996)47484950Irish Council for Bioethics Is It Time for Advanced Healthcare Directives? (2007).Costello ―The Terminally Ill-The Law‘s Concern‖ (1986) 21 Irish Jurist 35.355 A 2d 647 (1976): see paragraph 1.15, above.Costello ―The Terminally Ill – The Law‘s Concerns‖ (1986) 21 Irish Jurist 35, at42.21