ADVANCE CARE PLANNING AND THINK AHEAD

Sarah Murphy & Deirdre Shanagher

Today:• Think Ahead

• Advance care planning

• The Assisted Decision Making (Capacity) Act 2015

• Advance healthcare directives

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

Irish Hospice Foundation Programmes

Bereavement

Education &

Research

Healthcare Public Engagement

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

Person

centred

Want to

talk…Relieved

Don’t have to…

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

Key changes

1. Ward of Court system to be abolished - review of all wards2. New legal process to deal with decision-making for a relevant person in respect of a relevant decision3. New - Court process4. New role and office: Director of The Decision Support Service New Panels to be established by the Director5. New provisions for Enduring Powers of Attorneys6. New - advance healthcare directives

Functional Approach to Capacity:• Presumption of capacity

Responsibility of those questioning decision making capacity to prove there is an issue…

• Time and issue specific

Functional Approach to Capacity:

• Understand• Retain• Weigh• Communicate

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).

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.

What makes an advance healthcare directive legal? 1. At the time in question a person lack decision making capacity to give consent to the treatment2. The treatment to be refused is clearly identified in the advance healthcare directive3. The circumstances in which the refusal of treatment is intended to apply are clearly identified in the advance healthcare directive4. 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.

Think Ahead:

Think Ahead formIncludes an advance care directive compliant with the new legislation

Think Ahead formThink

Talk

Tell

Record

Review

Sections:1. Key Information2. Care Preferences (AHD and emergency summary form)3. Legal4. Financial5. When I Die

Think Ahead website

Think Ahead so far:

Guidance Document 2:

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

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

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.

Advance Care Planning:

Guidance Documents:

For more information:

Deirdre ShanagherDeirdre.shanagher@hospicefoundation.ieSarah MurphySarah.murphy@hospicefoundation.ie

Thank you & Questions