Health decisions and capacity for choice


Sir, – Prof Des O’Neill (Letters, June 25th) comments on a case in which the Dutch supreme court exonerated a doctor who administered euthanasia to a 74-year-old woman living with dementia (World,< June 23rd).

According to reports of the case, this was in compliance with the woman’s wishes as previously expressed in a “living will” but at the time of her death there were indications that she had changed her mind. The court held that the doctor had acted in her patient’s best interests.

Drawing on this example, Dr O’Neill cautions against binding advance healthcare directives, which “deny our ever-changing future selves”.

The Assisted Decision Making (Capacity) Act 2015 when fully commenced will provide for advance healthcare directives. The stated purpose is to allow persons to be treated according to their will and preferences and to provide healthcare professionals with information about persons in relation to their treatment choices. An advance healthcare directive will not become applicable while the person still has capacity to give or refuse consent to treatment.

The 2015 Act contains mandatory guiding principles. A person is presumed to retain capacity until the contrary is shown and a person shall not be considered to be unable to make a decision unless all practicable steps have been taken without success to help him or her to do so.

As Prof O’Neill writes, we can participate in care decisions to the end, and our communications should be facilitated and respected. These considerations are consistent with advance healthcare directives as provided for under the 2015 Act.

The 2015 Act mandates respect for dignity, bodily integrity, privacy and autonomy. “Best interests” are not mentioned. For the avoidance of any doubt, the Act expressly states that recognition of advance healthcare directives does not in any way affect the current law prohibiting euthanasia. – Yours, etc,



Decision Support Service,

Mental Health Commission,

Waterloo Road, Dublin 4.