The Irish Medical Organisation is pleased to make a submission on the Draft General Scheme for Advance Healthcare Directives for Incorporation in to the Assisted Decision-Making (Capacity) Bill 2013 to the Department of Health as part of consultation activities for the preparation of legislation.

In this submission, some of the main points that the IMO wished to bring to the attention of the Department of Health were:

• The IMO would advise patients to make an advance care plan rather than a legally-binding advance care directive.
• While advance care-planning is an important part of overall care there has been increasing professional concern over the utility of advance care directives.
• It is quite likely that for the vast majority of patients who are likely to develop impaired capacity sufficient to interfere with even supported decision-making that it will never be possible to legislate for – or to legislate away – the enormous complexity of individual decision-making as the end of life approaches, and there is a real risk that legally-binding directives may serve as an obstacle rather than a support to good end-of-life planning.
•  An advance treatment plan has the same ethical status as a decision by a patient at the actual time of an illness and should be respected on condition that:

-          The decision was an informed choice, according to the principles of informed consent.

-          The decision covers the situation that has arisen, and

-          The patient has not changed their mind.