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

care directive. 105 The Commission has already noted that many advance caredirectives may not be in writing, but agrees that the maker should communicatetheir wishes to family, friends and health care professionals. In the UnitedStates of America, when an advance care directive is registered through ahealthcare provider it is stored in the US Living Wills Registry. 106 In Singapore,an advance care directive must be registered as a health provider is prohibitedfrom acting on an unregistered directive. 107 In Denmark, a physician is obligedto check the national Living Will Data Bank (Livstestamenteregistret) before lifeprolongingtreatment is commenced. 1083.95 The Commission notes that the Department of Health and Childrenhas been involved in public consultation on a proposed Health Information Bill.The main purposes of the Bill would be to:introduce a Unique Health Identifier;support the establishment of population registers;clarify the legal and ethical rules on the use and disclosure of healthcare information; anddefine ―personal health information‖ 109Thus the Bill could include requirements that would be consistent with theconcept of the storage of advance care directives in a register. This centralsystem could be managed by the proposed Office of Public Guardian or by anon-statutory body such as the Irish Hospice Foundation. Such a system wouldbe particularly relevant to written advance care directives. At the time of writing(September 2009), it remains unclear when the proposed Health Information Billwill be published or enacted. The Commission considers, nonetheless, that theprinciple of establishing a register of advance care directives would be verymuch in the interests of all involved, the maker, the health care proxy (if any)and all health care professionals. In the absence of a Health Information Actthat might include such a register, the Commission considers that it would befeasible to begin the process of developing a less formal register of advancecare directives, and that suitable guidance on its development could be given inthe proposed Code of Practice on Advance Care Directives.105106107108109Mental Capacity Act 2005-Code of Practice, at paragraph 9.38.See www.livingwillregistry.com.Section 5(3) of the Advance Medical Directive Act 1996 (Singapore).Section 4 of §26 of the Health Act 2005.For more on the Health Information Bill seehttp://www.dohc.ie/issues/hib/synopsis.pdf?direct=184