Living Will / Advance Healthcare Directive (Ireland)

A Living Will / Advance Healthcare Directive in Ireland records a person's decisions to refuse specified medical treatment for use if they later lose the capacity to consent, with its legal effect set by the Assisted Decision-Making (Capacity) Act 2015 (Part 8). It allows a competent adult to record binding refusals of treatment in advance.

The Assisted Decision-Making (Capacity) Act 2015 is landmark legislation that replaced the outdated wardship system under the Lunacy Regulation (Ireland) Act 1871 with a modern, rights-based framework for supporting adults with capacity difficulties in Ireland. The Act implements Ireland's obligations under the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD), which Ireland ratified in 2018. The ADM(C) Act 2015 was amended by the Assisted Decision-Making (Capacity) (Amendment) Act 2022, and its provisions — including Part 8 on Advance Healthcare Directives — came into full operation on 26 April 2023 following the commencement of the remaining provisions by S.I. No. 115 of 2023.

Part 8 of the ADM(C) Act 2015 (sections 82 to 104) provides the statutory framework for advance healthcare directives. Section 85 of the ADM(C) Act 2015 gives legal recognition to binding AHDs, providing that a valid AHD must be respected by healthcare professionals and overrides any contrary instruction given while the directive-maker lacks capacity. An AHD can include both expressions of preference (wishes about preferred treatments, values, and goals of care) and binding refusals of specific treatments — including refusals of life-sustaining treatment (such as CPR, ventilation, or artificial nutrition and hydration) in specified circumstances. The distinction between a non-binding preference and a binding refusal is critical: only a binding refusal that meets the formal requirements of section 99 (and, for life-sustaining treatment, section 100) of the ADM(C) Act 2015 is legally enforceable against healthcare professionals.

The Decision Support Service (DSS), established under section 8 of the ADM(C) Act 2015 and operating under the aegis of the Department of Justice, is responsible for supervising the operation of the Act, providing guidance to directive-makers and healthcare professionals, maintaining registers of AHDs and designated healthcare representatives, and investigating complaints about compliance with the Act. The DSS provides model AHD forms and advisory notes on its website (decisionsupportservice.ie). While registration of an AHD with the DSS is not currently mandatory, it is strongly recommended as it confirms that the AHD is accessible to healthcare professionals in an emergency and provides a public record that protects the directive-maker's expressed wishes.

The constitutional foundation for Advance Healthcare Directives in Ireland is the right to bodily autonomy and self-determination — recognised by the Supreme Court in In re a Ward of Court (withholding of medical treatment) [1996] 2 IR 79 — which includes the right to refuse medical treatment, even life-sustaining treatment. This constitutional right is given statutory expression by the ADM(C) Act 2015 through the AHD mechanism, providing legal certainty and a clear framework for both directive-makers and healthcare professionals. The Act also introduces the role of the Designated Healthcare Representative (DHR) — a person appointed by the directive-maker to make healthcare decisions on their behalf in circumstances not specifically addressed in the AHD — giving directive-makers a greater degree of control and personalisation over their future healthcare planning.

An Irish Advance Healthcare Directive is needed by any adult who wishes to confirm that their values, wishes, and preferences regarding medical treatment are known and respected if they ever lose the ability to communicate or make decisions for themselves — whether due to illness, accident, dementia, or any other condition affecting capacity.

You need an Advance Healthcare Directive when you are: an adult who wants to confirm that your wishes about medical treatment — including any treatment you would or would not want to receive — are recorded and legally binding on healthcare professionals in the event of future incapacity; an adult who has received a serious diagnosis (such as cancer, dementia, or another progressive illness) and wants to plan for future care decisions in advance while you have full capacity; an adult who has strong views about certain medical interventions — such as CPR, artificial ventilation, artificial nutrition and hydration, or blood transfusions — and wants to confirm those views are respected in an emergency or intensive care setting; an adult who wants to appoint a trusted family member or friend as a Designated Healthcare Representative (DHR) with authority to make healthcare decisions on your behalf, within limits you specify; or a family member, carer, or healthcare professional seeking guidance on how to support an adult in making an Advance Healthcare Directive.

From a practical perspective, an Advance Healthcare Directive is one of the most important documents an adult can make as part of a thorough estate and personal planning process, alongside a will and an enduring power of attorney. Together, these three documents — a will (dealing with the distribution of assets on death), an enduring power of attorney (dealing with financial and property decisions during incapacity), and an Advance Healthcare Directive (dealing with healthcare decisions during incapacity) — provide a complete framework for protecting an adult's interests and wishes in all circumstances.

The ADM(C) Act 2015 came into full operation on 26 April 2023, giving statutory recognition to AHDs in Irish law for the first time. Adults who previously made informal living wills or advance directives under the pre-ADM(C) Act common law framework should review and if necessary replace those documents with a new AHD that complies with the formal requirements of the ADM(C) Act 2015 — particularly if they include a binding refusal of life-sustaining treatment, which now requires certification by a registered medical practitioner.

For older adults, those with dementia or other cognitive conditions, and those facing serious illness or end-of-life decisions, making an AHD while they still have capacity is a matter of urgency. The ADM(C) Act 2015 requires the directive-maker to have capacity at the time of making the AHD — once capacity is lost, it is too late to make a valid AHD. Healthcare professionals, social workers, and solicitors working with vulnerable adults should actively encourage and support their clients in making AHDs at the earliest opportunity.

A thorough Irish Advance Healthcare Directive compliant with Part 8 of the Assisted Decision-Making (Capacity) Act 2015 should contain the following key provisions and information.

The directive-maker identification clause identifies the person making the AHD by full legal name, address (including Eircode), date of birth, and PPS number. The clause should confirm that the directive-maker is aged 18 or over and has capacity to make the AHD at the time of signing.

The capacity statement clause confirms that the directive-maker has capacity at the time of making the AHD — that they understand the nature and effect of the directive, understand the consequences of the decisions set out in it, and are making it freely and voluntarily without undue influence. For AHDs containing binding refusals of life-sustaining treatment, a registered medical practitioner must countersign this clause (under section 100 of the ADM(C) Act 2015).

The values and beliefs clause sets out the directive-maker's personal values, beliefs, religious or cultural preferences, and goals of care, to guide healthcare professionals and the DHR in applying the AHD to specific circumstances. This clause provides important context for the specific treatment preferences set out in the directive.

The healthcare preferences clause expresses the directive-maker's wishes regarding healthcare treatment in specified circumstances — for example: the preference to receive palliative care focused on comfort rather than curative treatment in the event of a terminal illness; the preference to remain at home or in a hospice rather than in an intensive care unit; the preference for or against certain interventions such as artificial nutrition and hydration, mechanical ventilation, or dialysis.

The binding refusal of treatment clause (optional but important) sets out any specific medical treatment the directive-maker refuses in specified circumstances. This may include: refusal of cardiopulmonary resuscitation (CPR) in specified circumstances; refusal of artificial ventilation; refusal of artificial nutrition and hydration by tube in the event of irreversible unconsciousness; or refusal of blood transfusions (for religious reasons). Each refusal must specify the circumstances in which it applies and must be clear and unambiguous. A binding refusal of life-sustaining treatment must be countersigned by a registered medical practitioner under section 100 of the ADM(C) Act 2015.

The designated healthcare representative clause (optional) appoints one or more DHRs by full name, address, and contact details, defines the scope of their authority (including any limits the directive-maker wishes to impose), and confirms the DHR's acceptance of the appointment (by the DHR's signature). The clause should specify what the DHR is authorised to do in circumstances not specifically addressed in the AHD.

The review and amendment clause records the date of the most recent review of the AHD and any amendments made since it was first executed, to confirm the AHD reflects the directive-maker's current wishes.

The execution and witnessing clause records that the AHD was signed by the directive-maker and by at least two witnesses (each aged 18 or over, not the DHR, not a healthcare professional involved in the directive-maker's care, and not a person who may inherit on the directive-maker's death), together with the date of execution and each signatory's details. For AHDs containing binding refusals of life-sustaining treatment, the registered medical practitioner's signature, Irish Medical Council (IMC) registration number, and certification of capacity must be included.

The registration clause records the Decision Support Service registration reference number (if the AHD has been registered with the DSS), which enables healthcare professionals to locate and access the AHD through the DSS register. The forms-legal.com Living Will / Advance Healthcare Directive (Ireland) template covers the mandatory elements under the Assisted Decision-Making (Capacity) Act 2015.