Advance Healthcare Directive Ireland: What Families Need to Know
Advance Healthcare Directive Ireland: What Families Need to Know
Many families assume that setting up an Enduring Power of Attorney covers everything — including medical decisions. It does not. Under Irish law, an EPA handles finances, property, and personal welfare, but it cannot include healthcare treatment decisions. If your parent wants to outline their wishes about medical treatment refusals or appoint someone to advocate for those wishes, they need a separate document: an Advance Healthcare Directive.
What an Advance Healthcare Directive Covers
An AHD allows a person to record their preferences about future medical treatment while they still have the capacity to make those decisions. It takes effect only when they lose that capacity. There are two components:
Treatment requests. These express what treatments the person would like to receive. Under the Assisted Decision-Making (Capacity) Act 2015, treatment requests are not legally binding — but healthcare professionals must take them into account when making clinical decisions.
Treatment refusals. These are legally binding. If your parent specifies that they refuse a particular treatment (such as artificial ventilation, tube feeding, or resuscitation) and the AHD is valid and applicable to the situation, the healthcare team is legally required to honour that refusal.
This distinction matters enormously. A treatment refusal in a properly executed AHD carries the force of law. A treatment request does not — it guides but does not bind.
The Designated Healthcare Representative
When creating an AHD, your parent can appoint a Designated Healthcare Representative. This person does not make medical decisions themselves. Their role is to:
- Ensure healthcare professionals are aware the AHD exists
- Interpret the directive's terms in specific clinical situations
- Advocate for the person's expressed wishes when they cannot do so themselves
The representative acts as a bridge between the written document and the real-time clinical decisions being made. Without one, an AHD can sit in a drawer while doctors make decisions without reference to it.
How an AHD Differs from an EPA
The confusion between these two documents leads to real problems. Here is what each covers:
| Area | EPA | AHD |
|---|---|---|
| Bank accounts and finances | Yes | No |
| Property sales and management | Yes | No |
| Personal welfare (housing, daily care) | Yes | No |
| Healthcare treatment requests | No | Yes (non-binding) |
| Healthcare treatment refusals | No | Yes (legally binding) |
If your parent only has an EPA, there is a legal gap in their healthcare coverage. If they only have an AHD, there is a gap in their financial and property management. The two documents complement each other — they are designed to be used together.
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Creating an Advance Healthcare Directive
There is no single mandatory format for an AHD in Ireland. The Act requires that the person has capacity when creating it, that they are acting voluntarily, and that the directive is clear about which treatments are being refused or requested.
In practice, most AHDs are created with the help of a solicitor or GP who can ensure the document is specific enough to be actionable in a clinical setting. Vague statements like "I don't want to suffer" are difficult for healthcare teams to interpret. Specific statements about named treatments and named circumstances are far more useful.
The AHD does not need to be registered with the Decision Support Service. Unlike an EPA, there is no portal process or registration fee. However, the person should ensure that their GP, their Designated Healthcare Representative, and close family members all know the AHD exists and where it is stored.
Important Limitations
An AHD in Ireland does not apply to mental health treatments covered by the Mental Health Acts. It also cannot be used to request a treatment that a healthcare professional considers clinically inappropriate — the refusal power is stronger than the request power.
If the healthcare team believes the AHD was made under duress, was based on incorrect information, or does not apply to the specific clinical situation at hand, they can depart from it — but they must document their reasons and notify the Designated Healthcare Representative.
Getting Both Documents in Place
The practical advice for most families is straightforward: set up an EPA to cover finances and property, and an AHD to cover healthcare wishes. Together, they ensure your parent's preferences are protected across every major decision area.
The Enduring Power of Attorney and Decision Support Guide for Ireland covers how the EPA and AHD work together under the Assisted Decision-Making Act, including how to coordinate the Designated Healthcare Representative role with the EPA attorney appointment.
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