PEOPLE SHOULD be able to refuse in advance medical treatment in the event of their becoming incapacitated by serious accident or illness, according to the Law Reform Commission.
The proposal comes in a consultation paper to be launched at a conference organised by the commission on advance care directives in Dublin today.
Advance care directives have been legislated for in a number of states. They provide for people aged over-18 to specify what treatments they do not wish to have in the event of being incapacitated by serious accident or illness, like a stroke or Alzheimer's disease, and of being unable to communicate their wishes as a result.
These directives have developed in the context of technological medical advances that allow people to be kept alive with the aid of machines for very lengthy periods and with no prospect of recovery.
No legislation exists in Ireland providing for guidance from the patient in such circumstances, and the commission provisionally proposes that advance care directives be given a legislative framework.
Under the consultation paper, such directives would not provide for euthanasia or the refusal of basic life-sustaining nourishment. Nor would they provide for positive instructions on what kind of treatment the patient would like to receive.
They would be negative requests, specifying what kind of treatment the patient did not wish to receive.
Where the rejected medical treatment was of a life-sustaining nature, the commission recommends that medical advice should be obtained before the making of an advance care directive, and that it should be in writing and witnessed.
However, in other circumstances, oral directives would also be valid.
The commission has asked for submissions on whether artificial nutrition and hydration are life-sustaining medical treatments.
The directives would relate to treatment for physical conditions only, and would not relate to treatment for mental illness.
The commission provisionally recommends that a healthcare proxy could be appointed in an advance care directive.
This would be a person, normally a family member, who would liaise with medical staff in implementing the directive and ensure that the person's wishes were carried out.
The commission also provisionally recommends that refusal of treatment on religious grounds in advance care directives be permitted. This issue has been explored by the courts recently in relation to Jehovah's Witnesses, who, on religious grounds, do not accept blood transfusions.
The report also spells out the circumstances in which an advance care directive would not be considered valid or applicable.
This would include where the person making it did not have legal capacity at the time; where it was not a voluntary act; where the person changed their mind and communicated this; where the directive was ambiguous in relation to the proposed treatment, and if the author said or did anything to put reasonable doubt in the mind of the doctor that they had changed their mind, but did not have the opportunity to revoke the directive.
The conference, which will be opened by Minister of State for Health, Máire Hoctor, in Dublin Castle this morning, will include contributions from Patricia Rickard-Clarke of the Law Reform Commission, who will introduce the paper, and from experts in palliative and end-of-life care, law and the hospice movement.
Submissions on the issues raised in the consultation paper will be considered by the commission before it drafts its report on the subject, which forms part of its 2008-2014 Programme for Law Reform. They must be received by January 31st, 2009.