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

e upheld. Indeed, this conclusion follows from the experience in other States,including the United States and the UK.1.62 In the absence of a clear legislative framework, the Commissionacknowledges that health care professionals have faced difficulties in dealingwith the many complex issues arising from advance decision making. TheCommission has concluded that, due to the complexity of many of the issuesinvolved, a clear statutory framework is necessary. In light of the general settingof the law on capacity in which advance care directives are considered, it isappropriate that this legislative framework should be placed within the widerframework of the reform of the law on mental capacity. The Commissiontherefore recommends that an appropriate legislative framework should beenacted for advance care directives, as part of the wider context of reform of thelaw on mental capacity in the Government‘s Scheme of a Mental Capacity Bill2008.1.63 The Commission recommends that an appropriate legislativeframework should be enacted for advance care directives, as part of the reformof the law on mental capacity in the Government‟s Scheme of a MentalCapacity Bill 2008.(7) The legislative framework in a wider health care setting1.64 In the Commission‘s view, any legislative framework must be seen inthe context of the ongoing development of good medical practice. In thatrespect, the Commission considers it important not to see an advance caredirective merely as an end in itself – a legal ―event‖ so to speak – but also aspart of a wider process that could facilitate the development and improvementof healthcare planning.1.65 Central to healthcare planning is good communication betweenpatients and medical professionals. Good communication results in improvedinformed decision making, which is consistent with the concept of informedconsent and greater patient autonomy. This should also form part of anyproposed legislative scheme for advance care directives. 87 In developing theconcept of a health care plan, the patient is encouraged to make decisionsabout their overall care plan. In order for this to reflect reality advice can andshould be sought from doctors, nurses, midwives or other health careprofessionals. 88 Treatment should be explained to patients in a way they canunderstand and they should be encouraged to ask questions. Through thisprocess, the patient can then make an informed and truly autonomous decision.8788See paragraphs 1.86-1.95, below.For more on healthcare professionals see paragraphs 3.02-3.05.29