The concept of advance care planning outlined. The Assisted Decision Making (Capacity) Act 2015. Using Think Ahead as a tool to engage with advance care planning and with advance healthcare directives

1. ADVANCE CARE PLANNING AND THINK
AHEAD
Sarah Murphy & Deirdre Shanagher

2. Today:
• Think Ahead
• Advance care planning
• The Assisted Decision Making (Capacity) Act 2015
• Advance healthcare directives

3. Irish Hospice Foundation
Our Vision is that no one
should face death or
bereavement without the care
and support they need
Our Mission is to strive for the
best care at end of life for all

4. Irish Hospice Foundation Programmes
Bereavement
Education &
Research
Healthcare Public
Engagement

6. Advance Care Planning:
• A process of discussion and reflection about goals ,
values and preferences for future treatment in the context
of an anticipated deterioration…
• Enhances end of life care by ensuring a persons voice is
heard
Want to
talk… Don’t
have
to…

7. The Assisted Decision Making (Capacity)
Act 2015:
• Replaces the Lunacy Regulation (Ireland) Act 1871
• Includes provision for Advance Healthcare Directives
which were previously legal under common law but had
no legislative underpinning.
• Codes of Practice/Guidelines for full implementation
required
• Minister for Justice will commence most of the Act
• Minister for Health will commence the AHD section

8. Key changes
1. Ward of Court system to be abolished - review of all wards
2. New legal process to deal with decision-making for a relevant
person in respect of a relevant decision
3. New - Court process
4. New role and office:
Director of The Decision Support Service
New Panels to be established by the Director
5. New provisions for Enduring Powers of Attorneys
6. New - advance healthcare directives

9. Functional Approach to Capacity:
• Presumption of capacity
Responsibility of those questioning decision
making capacity to prove there is an issue…
• Time and issue specific

10. Functional Approach to Capacity:
• Understand
• Retain
• Weigh
• Communicate

11. Advance Healthcare Directives:
• A document where a person can write down what they
would not like to happen in relation to certain medical care
treatments
• Only comes into force when a person loses capacity,
becomes ill and the circumstances in their advance
healthcare directive arise. (A record of advance healthcare directives will
be held by the Director of Decision Support Services).

12. Issues that may be covered in an advance
healthcare directive:
• Treatments that a person would refuse in the future – this is legally
binding
• A request for a specific treatment. This is not legally binding but must be taken
into consideration during any decision-making process which relates to treatment for the
person in question if that specific treatment is relevant to the medical condition for which
the person may require treatment.

13. What makes an advance healthcare
directive legal?
1. At the time in question a person lack decision making
capacity to give consent to the treatment
2. The treatment to be refused is clearly identified in the
advance healthcare directive
3. The circumstances in which the refusal of treatment is
intended to apply are clearly identified in the advance
healthcare directive
4. The advance healthcare directive was made voluntarily.
5. The advance healthcare directive was not altered or
revoked.
6. The person did not do anything inconsistent with the terms
of the advance healthcare directive while they had decision
making capacity.

14. Think Ahead:

15. Think Ahead form
Includes an
advance care
directive
compliant with
the new
legislation

16. Think Ahead form
Think
Talk
Tell
Recor
d
Revie
Sections:
1. Key Information
2. Care Preferences (AHD
and emergency summary
form)
3. Legal
4. Financial
5. When I Die

17. Think Ahead website

18. Think Ahead so far:

24. Guidance Document 2:

25. Guidance for healthcare professionals:
• Understand decision making supports that are available
• Presuming decision-making capacity
• Maximising decision-making capacity
• Assessing decision making capacity
• Making decisions if decision-making capacity is an issue

26. Assessing decision-making capacity:
• Consider what decision has to be made
• Do not discriminate
• Is there something currently happening that may
temporarily affect the person’s decision-making capacity
• Consider what supports have been provided
• Consider if decision-making capacity is absent even with
all practicable support

27. If decision-making capacity is an issue:
1. Support the person to be involved in the decision-
making process by engaging in capacity building and
maximising.
2. Consider the level of support that the person
requires to make the decision in question.
3. Seek evidence of previously expressed
preferences.
4. Consider which option, including not to treat, would
be least restrictive of the person’s future choices.
5. Consider the views of anyone indicated by the
person. These people may be those appointed by
the person to support them when making decisions.
6. A Consider involving advocacy support.

28. Advance Care Planning:

29. Guidance Documents:

30. For more information:
Deirdre Shanagher
Deirdre.shanagher@hospicefoundation.ie
Sarah Murphy
Sarah.murphy@hospicefoundation.ie
Thank you & Questions