What can an Advanced Healthcare Directive Cover?

An Advanced Healthcare Directive can cover a number of important areas.

1. Refusing Certain Treatments

You can legally refuse specific medical treatments in advance, such as:

• Life-sustaining treatment in certain circumstances
• Artificial Feeding
• CPR
• Ventilation

If properly completed, a valid refusal must be followed by doctors.

2. Expressing Your Wishes

You can also include your preferences around care, such as:

• Where you would prefer to be cared for
• Your comfort preferences
• Religious or personal wishes

These wishes are not legally binding, but doctors must take them into account.

3. Appointing a Healthcare Representative

You can name someone you trust to:

• speak to doctors on your behalf
• make healthcare decisions on your behalf
• help ensure your wishes are respected

This person only acts if you lose capacity.

 

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What it is Not:

It is important to understand what an Advanced Healthcare Directive is not. It is not:

• A will
• About money or property
• A funeral plan
• Something that takes effect immediately

It only relates to medical decisions if you can no longer make or communicate those decisions yourself.

 

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Is It Legally Binding in Ireland?

Yes - under the Assisted Decision-Making (Capacity) Act 2015, a valid refusal of treatment in an Advanced Healthcare Directive is legally binding.

Doctors must follow it.

 

I am giving you a blank Advanced HealthCare Directive (AHD) to print off, complete and place in The Journey Folder. Make sure to let your representative know where it is held. The AHD I am providing you clearly sets out how to properly and legally complete the form so that it is valid. But I want to give you a few examples of how someone might complete it because you may not me a medic and may not be familiar with the treatments that may be offered if you did lose capacity.

Your Advanced Healthcare Directive Template

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A Real Life Example:

Let’s take the example of Mary.

Mary is 78. She is a widow and has four adult children.

She is admitted to hospital with severe pneumonia. Her condition suddenly worsens and she becomes unconscious. The doctors now need consent to make important medical decisions.

Her children are asked, “What would your mum have wanted?”

They look at each other, but no one is sure.

In situations like this, families may be asked to make decisions about treatments such as ventilation, artificial feeding, dialysis, or high-risk surgery. These decisions are incredibly difficult, especially when there has never been a conversation or written guidance.

Without an Advanced Healthcare Directive, family members can find themselves disagreeing, doubting themselves, or carrying guilt long after the crisis has passed.

With an Advanced Healthcare Directive, the person’s wishes are already there in writing. It removes guesswork and helps guide decision-making at an already emotional time.

The Decisions Family Be Asked To Make:

 

1. A Ventilator (Breathing Machine)

Mary cannot breathe properly.

The doctor explains: "We can place her on a ventilator in ICU. It involves inserting a tube into her throat.”

This may save her life. But if she is very frail, it may only prolong dying.

Without guidance, the children struggle:

“Do everything.”

“She wouldn’t want this.”

“What if we’re wrong?”

If Mary had written in her directive:

“If I am unlikely to recover to a meaningful quality of life, I refuse mechanical ventilation.”

The decision is clear.

The children are not left guessing.

 

2. Artificial Feeding (Feeding Tube)

Mary cannot swallow.

The team asks: “Should we insert a feeding tube?”

This could keep her alive long-term but possibly without awareness or recovery.

If Mary had written:

“If I am permanently unconscious or have no realistic prospect of recovery, I do not want artificial feeding.”

Her wishes are respected.

Her children are relieved of that burden.

 

3. Dialysis (Kidney Failure)

Mary’s kidneys begin to fail.

Doctors explain: “Dialysis could keep her alive, but it would mean ongoing hospital treatment several times a week.”

If Mary had written:

“If my condition is irreversible, I do not wish to commence dialysis.”

Her children do not have to weigh life against suffering.

She has already made that choice.

 

4. High-Risk Surgery

Mary develops a serious complication that may require emergency surgery.

The doctor says: “We can operate, but the risks are significant and recovery may be very limited.”

If Mary had written:

“I do not wish to undergo high-risk surgery where the likelihood of returning to independent living is low.”

Her values guide the outcome.

 

Without an Advanced Healthcare Directive

The family debates.

Old tensions surface.

Someone feels guilty.

Someone feels pressured.

Someone worries forever:

“Did we do the right thing?”

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Section 2: Treatment I Do NOT Want To Receive

Here are some examples to help you complete section 2 of the ADH because we are not all medics and may not be aware right now of what treatments would be offered.

You might write:

Treatment: Mechanical ventilation (breathing machine).

Circumstances: If I have an irreversible condition such as a severe stroke, advanced dementia, or terminal illness, and there is no reasonable prospect of recovering to a meaningful quality of life.

 

Treatment: Artificial feeding and hydration (feeding tubes).

Circumstances: If I am permanently unconscious or in the final stages of a terminal illness with no prospect of recovery.

 

Treatment: Dialysis or high-risk major surgery.

Circumstances: If my doctors believe my condition is irreversible and I am unlikely to return to independent living or awareness.

 

Section 3: Treatment I Would Like To Receive

You might write:

Treatment: Full pain relief and comfort care, even if it may unintentionally shorten my life.

Circumstances: If I am dying or in significant pain with no realistic prospect of recovery.

 

Treatment: Antibiotics, fluids, oxygen and non-invasive treatment.

Circumstances: Where recovery to a meaningful quality of life is reasonably likely.

 

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Peace of Mind for You and Your Family

Your directive removes guesswork. Instead of your family having to debate difficult decisions in the middle of a crisis, your wishes can guide the outcome.

This may not be for everyone, and it may feel too overwhelming or sad to think about. That is completely understandable. But if it is something you worry about, or if you have experienced the upset and confusion of being asked to make these kinds of decisions for a parent or loved one, I hope this month’s resource and the Advanced Healthcare Directive will help to bring you some peace of mind.

Warmest regards,
Jacquelyn

Access the resources here:

Your Advanced Healthcare Directive Template