Advance Healthcare Directives in Ireland: A Guide for Care Staff

Knowing what someone would want if they could no longer speak for themselves is one of the hardest and most important things a care team can get right. In Ireland, Advance Healthcare Directives give people a legally recognised way to set this out in advance - and care staff need a clear understanding of how they work to support residents' wishes properly.

What is an Advance Healthcare Directive?

An Advance Healthcare Directive (AHD) is a legal document, introduced under Part 8 of the Assisted Decision-Making (Capacity) Act 2015, that allows a person to set out their wishes regarding medical treatment in advance, for a time when they may lack the capacity to make or communicate those decisions themselves. As described by Citizens Information's guidance on advance healthcare directives, a person can use an AHD to refuse specific treatments in defined circumstances, and can also appoint a Designated Healthcare Representative to make decisions on their behalf in line with their wishes.

This sits within the wider framework of the Act, which - as explained by the Law Society of Ireland - moved Irish law towards a presumption of capacity and supported decision-making, replacing older approaches that more readily assumed incapacity.

What an AHD can and cannot do

An AHD can include a refusal of specific treatments, which is legally binding on healthcare professionals if it's valid and applicable to the circumstances that have arisen. Requests for particular treatments can also be included, but these are not binding in the same way - a clinician isn't obliged to provide a specific treatment simply because it was requested in advance, particularly if it wouldn't be clinically appropriate. A person can also use an AHD to name a Designated Healthcare Representative, someone given legal authority to make treatment decisions in line with the person's wishes if they lose capacity.

Why this matters for care staff

Care staff won't typically be involved in drafting an AHD, but they play a real role in the practical side: knowing whether a resident has one, ensuring it's accessible in their care records, and understanding that its existence should shape how the care team responds if the resident later loses capacity to make treatment decisions themselves. A directive that exists but isn't known about, or isn't easily found when needed, offers no real protection to the resident's wishes.

• Check on admission, or as part of routine care planning, whether a resident has an AHD or has named a Designated Healthcare Representative
• Ensure any AHD is stored clearly in the resident's care record, not filed away where it might be missed in an urgent situation
• Understand who the Designated Healthcare Representative is, if one has been appointed, and how to contact them
• Flag to the wider clinical team promptly if a resident's condition changes in a way that might bring the directive into relevance

How this connects to capacity assessment more broadly

Advance Healthcare Directives sit alongside the wider principles of the Assisted Decision-Making (Capacity) Act - the presumption that a person has capacity unless shown otherwise, and the principle of supporting people to make their own decisions wherever possible. An AHD is, in effect, a person exercising that capacity in advance, for a time when they may no longer be able to exercise it directly - which is exactly why respecting a properly made directive matters so much.

Oversight and guidance

The Decision Support Service, established under the Act, provides guidance materials and oversight relating to Advance Healthcare Directives, including detailed notes on how they should be completed and applied. Care settings should ensure staff know where to find current guidance, rather than relying on informal understanding that may not reflect the latest position.

Starting the conversation sensitively

Bringing up Advance Healthcare Directives can feel difficult, but avoiding the topic entirely often does residents a disservice. Framing it as part of routine, person-centred care planning - alongside questions about preferences, routines and what matters most to someone - rather than a separate, weighty legal conversation, tends to feel more natural for both residents and staff. Involving family members where the resident wishes, and being honest that this is about ensuring their voice is heard rather than a sign of declining health, can help make these conversations feel supportive rather than alarming.

Frequently asked questions

Is an Advance Healthcare Directive the same as a will? No - a will deals with a person's estate after death, while an AHD deals specifically with medical treatment decisions during their lifetime, when they may lack capacity to decide for themselves.

Can a Designated Healthcare Representative override a valid AHD? No - their role is to make decisions in line with the person's wishes as expressed in the directive, not to override it based on their own preferences.

What should staff do if they're unsure whether an AHD applies to a current situation? Escalate to a senior clinician or manager promptly rather than making an assumption - applicability can depend on specific clinical circumstances that need proper judgement.

Understanding Advance Healthcare Directives helps care teams genuinely respect residents' wishes when it matters most. Build this knowledge with CPD courses for care and healthcare staff.