If you wish to plan ahead, you can make an advance healthcare directive (AHD). This lets you set out your wishes regarding treatment decisions in case you are unable to make these decisions in the future. Importantly, it lets you write down any treatment you do not want.
You can appoint someone you know and trust as your designated healthcare representative. Their role is to ensure your AHD is followed and to consent to or refuse treatments on your behalf based on your will and preferences outlined in your AHD.
You can find out more by clicking on the link to our Advance Healthcare Directives section.
You can read more about making an advance healthcare directive in our guidance material, which can be found in our Resources section.
You can download a booklet and form at the links below.
- Advance Healthcare Directive Information Booklet
- Advance Healthcare Directive Form
You will find a wide range of explainer videos on our YouTube channel at the link Decision Support Service Information Videos
Yes, if you are planning ahead for a time when you may not have capacity, you should consider making both an enduring power of attorney and an advance healthcare directive.
An enduring power of attorney may cover decisions relating to your property and affairs and personal welfare, or both, but cannot cover healthcare decisions. Only an advance healthcare directive can cover healthcare and treatment decisions.
It does not cost anything to make, change or cancel an advance healthcare directive.
The biggest benefit of making an advance healthcare directive is peace of mind. It gives comfort that your will and preferences relating to treatment decisions will be acted on and respected.
It may be particularly beneficial where:
- you have strong views about the kinds of healthcare treatment you wish to receive or refuse
- you have a life-limiting or terminal illness and want to make plans for your end of life care
- you have fluctuating capacity and want to continue to control your healthcare treatment during periods when you lack capacity to make healthcare decisions
- you have received a diagnosis of a progressive illness that may impact on your memory or ability to communicate
You can end your advance healthcare directive at any time if you have capacity to do so. You can also change your advance healthcare directive. Your advance healthcare directive only starts to apply if you lose capacity. It can be a good idea to review and update your advance healthcare directive on a regular basis to ensure that it reflects your wishes.
You should also review and update it following any major medical treatment or diagnoses to ensure it reflects your medical situation and your will and preferences.
Yes, you can change your advance healthcare directive (AHD) at any time so long as you have the capacity to do so. This is called a variation.
Any change to your AHD must be made in writing, signed by you, signed by your designated healthcare representative if you have one, and signed by two witnesses.
You should keep your AHD under review and make any necessary changes to make sure it reflects your current circumstances and treatment needs.
Yes, you should review your advance healthcare directive from time to time to make sure you remain happy with the decisions you have planned for. You may think of more things you wish to include in your AHD or your living or healthcare circumstances may have changed.
You can add or remove any decisions in your AHD as long as you have capacity to do so.
You cannot include any requests for treatments or refusal of treatments contrary to the law. For example, you cannot request medications that cannot legally be prescribed in Ireland.
You cannot refuse basic care. This includes (but is not limited to) warmth, shelter, oral nutrition, oral hydration and hygiene measures.
No, you do not have to appoint a designated healthcare representative (DHR). Your advance healthcare directive is still effective even if you do not have a DHR and will still be respected by healthcare professionals.
Any person, including you, can make a complaint to the Decision Support Service (DSS) about how a designated healthcare representative is exercising their powers. A designated healthcare representative must keep a record of any decision that they make that relates to your advance healthcare directive. The DSS can request a copy of this record if we receive a complaint.
If you have capacity to do so, you can cancel your advance healthcare directive (AHD) and create a new one with a new designated healthcare representative. If you want to cancel your AHD you must do this in writing and make sure that all people who have a copy of your previous AHD are made aware that you have cancelled it.
A healthcare professional will only follow your advance healthcare directive (AHD) if it is valid and applicable to the specific treatment that is being considered. If it is not clear whether the AHD should apply, the healthcare professional considering the directive may:
- consult with your designated healthcare representative, if you have one
- consult with other people you trust
- seek the opinion of another healthcare professional
- consider any other evidence of your will and preference
If it is still not clear, the healthcare professional will take action to preserve your life, where relevant.
An application may be made to court to make a determination on the matter.
You should make copies of your advance healthcare directive (AHD) and give them to your designated healthcare representative, general practitioner (GP), healthcare providers and loved ones as relevant and appropriate.
It can be a good idea to keep both hard and soft (digital) copies of your AHD. Don’t store it somewhere where no one will be able to access it.
If you make changes to your AHD, make sure everyone has the up-to-date version of your AHD to avoid potential conflicts.
No, there is no register of advance healthcare directives at this time.
If a person has lost capacity to make healthcare treatment decisions, they cannot make an AHD. In some urgent and emergency situations a healthcare professional may be able to make a treatment decision. Otherwise, if treatment is needed and the person cannot consent to the treatment and has not made an AHD, an application may need to be made to court for a declaration of capacity.
The court can make the decision itself (a decision-making order) or appoint a decision-making representative to make certain decisions on the person’s behalf.
You should make sure the healthcare professional has a copy of the advance healthcare directive (AHD). You can ask for the reason why the AHD is not being followed. A healthcare professional will only follow an advance healthcare directive (AHD) if it is valid and applicable to the specific treatment that is being considered.
If you are not happy with the reason given, you should ask the healthcare professional for their procedures for asking for a review or making a complaint.
If the matter cannot be resolved, an application may be made to the Circuit Court for a determination on the matter. Any matters relating to life-sustaining treatment must be considered by the High Court.
You should first check that the advance healthcare directive has been made properly. This includes the AHD being recorded in writing, signed and witnessed by two witnesses.
It is for the healthcare professional providing the relevant care and treatment to determine whether the AHD is valid and applicable. They must assess whether the treatment in question is clearly included within the AHD and whether any circumstances have changed since the relevant person made the AHD that would call into question whether the AHD reflects their current will and preferences.
Any refusals of treatment in your advance healthcare directive are considered legally binding when they are valid and applicable to the circumstances. Requests for treatment are not legally binding but must be taken into consideration and respected.
No, you do not need to notify the DSS of your advance healthcare directive (AHD). Your AHD is not registered with the DSS and there is no register of AHDs at this time.
No, your next of kin has no authority to put in place a DNAR for you. Your family and loved ones cannot make decisions relating to your end-of-life care on your behalf unless acting as your designated healthcare representative in accordance with your advance healthcare directive.
Yes, your advance healthcare directive needs to be witnessed by two people. Both witnesses must be over 18 and one of them cannot be your immediate family member.
You do not need a solicitor to make an advance healthcare directive (AHD). You may wish to consult with your doctor, healthcare providers or other trusted professionals about the decisions you are planning to include in your AHD.
No, you do not have to tell anyone that you’ve made an advance healthcare directive (AHD). However, you should make sure your doctor and any other healthcare professionals have a copy of your AHD. This is so that they are aware of and are able to follow your wishes as written down in your AHD.
You do not need a formal capacity assessment to make an advance healthcare directive (AHD). If you do not have capacity to make an AHD at the time you make it, a healthcare professional may consider it to be invalid.
Yes, you can make an advance healthcare directive (AHD) without making an enduring power of attorney (EPA). An AHD relates to healthcare treatment decisions and refusal of treatment. An EPA relates to property and affairs and personal welfare matters.
If you are planning ahead for a time when you may not have capacity, you should consider making both an AHD and an EPA.
You can write down any treatments you wish to refuse and the circumstances in which this should apply. This may include a specific medication, treatment, surgery or therapy. You can include requests for specific treatments; however, these requests are not legally binding. By including them you can make sure they are considered during any related decision-making process.
You can also name a designated healthcare representative who can help to make sure people are aware of and follow the advance healthcare directive. They can consent to or refuse treatments on your behalf based on your will and preferences outlined in your AHD.
An advanced healthcare directive cannot cover the refusal of ‘basic care’ which includes warmth, shelter, oral nutrition, hydration, and hygiene measures.
It can be difficult to think about all of the relevant treatments and circumstances to include in your advance healthcare directive (AHD). However, you should try to be as detailed as possible. This is to avoid disagreements at a later stage about whether or not you meant for your AHD to apply in a certain circumstance.
You should take your time and go through the available guidance and information.
You should also talk to your designated healthcare representative, if you are appointing one, so that they are sure about when you want your AHD to apply.
You should also keep your AHD updated if your circumstances change, for example, if you receive a diagnosis for a serious condition.