Consultation Paper on Bioethics - Law Reform Commission

Where there is no benefit in restarting the patient‟s heart and breathing;
Where the expected benefit is outweighed by the burdens.” 81
1.45 It is noted that, ideally, decisions regarding CPR should be made and
discussed in advance as part of overall care planning. They specifically state
that an advance decision refusing CPR should only be made after the
appropriate consultation and consideration of all relevant aspects of the
patient‟s condition, which include:
“the likely clinical outcome, including the likelihood of successfully
restarting the patient‟s heart and breathing, and the overall benefit
achieved from a successful resuscitation;
the patient‟s known or ascertainable wishes; and
the patient‟s human rights, including the right to life and the right to be
free from degrading treatment.” 82
1.46 In light of this, the Commission has provisionally concluded that the
status of DNR orders requires clarification in Irish law and invites submissions
on them
1.47 The Commission invites submissions on the status of “Do Not
Resuscitate” (DNR) orders.
(4) What forms of treatment cannot be refused in an advance care
directive
(a) Basic care
1.48 The right to refuse treatment has limitations. The Commission agrees
with the Law Commission for England and Wales that public policy demands
that:
“… an advance refusal of treatment should not preclude the provision
of „basic care‟, namely care to maintain bodily cleanliness and to
81 British Medical Association and Royal College of Nursing Decisions Relating to
Cardiopulmonary Resuscitation: A Joint Statement from the British Medical
Association, the Resuscitation Council (UK) and the Royal College of Nursing
(2002) at 11-12.
82 British Medical Association and Royal College of Nursing Decisions Relating to
Cardiopulmonary Resuscitation: A Joint Statement from the British Medical
Association, the Resuscitation Council (UK) and the Royal College of Nursing
(2002) at 7-8.
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