End-of-life issues and professional ethics


Sir, – The article “Doctors reject wills governing treatment” (News, November 8th) highlights the anxiety about the status of the advance healthcare directives (AHD) provisions of the Assisted Decision-Making (Capacity) Act 2015 (ADMA).

The ADMA is rooted in a human rights perspective, informed by the UN Convention on the Rights of Persons with Disabilities. Part 8 of the Act deals with the making of an AHD and provides a legislative underpinning for what is already legal in Irish case and common law. The Irish Medical Council Guide to Professional Conduct & Ethics and the NMBI Code of Professional Conduct for Registered Nurses & Midwives already deal with the status of an AHD. The HSE’s National Consent policy also upholds many of the key messages enshrined in the ADMA. What the ADMA does now require is complete consideration in the medical profession to the wishes and preferences of patients in their care.

The article highlights a need for information, support and training for health and social care professionals in relation to the implications for their practice arising from the Act. The HSE has published a draft Code of Practice on Advance Healthcare Directives for Health and Social Care Professionals which provides for conscientious objection.

When the Act is fully commenced a formal register of AHDs will be critical to its success.

It is also critical that doctors and their patients discuss advance care planning and the making of an AHD which, if it is the patient’s wish, would prevent unwanted medical intervention when nearing end of life. This can only be of benefit to all in the event that the patient becomes unable to speak for themselves, allowing their dignity and autonomy to be preserved. An AHD may also help to ease the decision-making burden in a time of crisis.

The Irish Hospice Foundation encourages everyone to consider, discuss and record their preferences for end of life care and treatment. Our Think Ahead form contains a format for the making of an AHD which is in line with the provisions of the Act. Citizens completing the form are encouraged to discuss their will and preferences for care and treatment choices with their doctor. – Yours, etc,


Development Officer,

Irish Hospice Foundation,

Nassau Street,

Dublin 2.