(4/5) Advance Health Directive — What is it Worth?

This is the fourth blogpost telling my story of making my end-of life arrangements. If you missed the earlier posts catch up here

Over the last couple of blogs I have been recounting my experience of completing an Advance Healthcare Directive, to explain my wishes about my treatment at the end of life, especially in case I am unable to communicate at the time.

In this post, I want to talk about the limitations of the Advance Healthcare Directive. There are two aspects to this: its legal standing and what you can’t ask for, namely a voluntary assisted death. (I’ll have more to say about the second in the next post.)

An Advance Healthcare Directive has no formal legal standing. I‘ll explain why in a moment, but first let’s consider why you should bother to complete a directive if it has no legal force. The main reason is to set out your wishes. In doing so, you will have to clarify your thinking, as I did, and decide what is important for you in your life. You will also have to involve others in your family in your thinking, because they will be responsible for seeing that your wishes are respected.

The formal legal position is that Advance Healthcare Directives are described in the Assisted Decision-Making (Capacity) Act of 2015. That’s the good news. But the bad news is that the relevant section of that Act is still in the throes of ‘public consultation’ and has not been ‘commenced’. That means that it is not yet a legal provision, although it may be — one day.

That said, Advance Healthcare Directives are recognised by healthcare professionals. For example, the Medical Council’s Guide to Professional Conduct and Ethics for Registered Medical Practitioners says that a directive should have ‘the same status as a decision by a patient at the actual time of an illness and should be followed’. That is subject to some obvious conditions, such as the patient has not changed his/her mind and was competent to make the Directive in the first place.

In the  third post I stressed the importance of making sure all the professionals involved in your care know about your Directive. You will need to make a point of handing a copy to any consultants who are going to be looking after you for any significant length of time. If you are staying in hospital, bring a copy with you and try to get it logged onto your file.

If you have a solicitor, s/he should also have a copy of your Directive.

I should point out that the only place where you can get a simple AHD such as this is on our website. The organisation that produced it is no more. The Irish Hospice Foundation produced the downloadable Think Ahead, which covers all end-of life issues, including an Advance Healthcare Directive. It’s friendly but I found it a bit intimidating and preferred to just complete the Directive for now.

In the next post, I‘ll talk about the one thing you can’t ask for in your Directive and that is Voluntary Assisted Dying.