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

the advance care directive and the type of health care treatment or treatmentsbeing refused.3.45 As already mentioned in the context of unwritten advance caredirectives, 53 an individual may not have made a written advance care directivebut will have clear views as to refusal of certain forms of treatment when aparticular situation arises, such as when admitted to the Accident andEmergency Department of a hospital or in the period immediately beforesurgery. Where an individual communicates their wishes to a health careprofessional, that decision is often likely to be recorded in their medical notesand charts. The Commission considers that, where this occurs, the recordedmedical notes may be regarded as a written advance care directive. It may bethat there is disagreement about whether the recorded information accuratelyreflects the individual‘s wishes, in particular where the individual has not beeninvolved in drawing up the written record. The Commission considers that thisdifficulty may be overcome in time through the development of good guidanceon the content of advance care directives in the proposed Code of Practice onAdvance Care Directives.3.46 The Commission also considers that, in keeping with the view thatmaking an advance care directive should not place an undue burden onindividuals, other clear expressions of wishes should be deemed to be writtenadvance care directives. These would include, for example, ―no blood‖ cardswhich members of the Jehovah‘s Witness faith carry to state that they do notconsent to blood transfusions.3.47 To conclude this section, the Commission accordingly recommendsthat an advance care directive that involves a refusal of life-sustaining medicaltreatment must be in writing (and that ―writing‖ includes both manual andautomated record-keeping processes). The Commission also recommends that,where an individual chooses to prepare a written advance care directive (or isrequired to do so because it involves life-sustaining treatment), it need not be ina prescribed form but must contain certain core information, such as: name ofperson making the advance care directive, date of birth, address, health careproxy (if any), and name and address of general practitioner or other healthcare professional. The Commission also recommends that the proposed Codeof Practice on Advance Care Directives should contain guidance on whatshould be included in the advance care directive. The Commission alsorecommends that a refusal of treatment recorded on a person‘s medical chartsor notes may be deemed to be a written advance care directive and that a clearwritten statement in the form of for example, a ‗no blood‘ card is deemed to bean advance care directive.53See paragraph 3.36, above.69