According to media reports this morning (Irish Times | RTE), the Irish Council for Bioethics will today publish a report on the ethical and legal issues surrounding the structure, content and practicality of implementing advance directives or living wills. This is a very important development, much to be welcomed.
Advance directives or living wills are a statement of someone’s wishes and views regarding matters such as the forms of medical treatment to be administered or not, in circumstances where the person concerned is not in the future in a position to decide or communicate about such matters. They are prepared when the persons concerned are mentally capable to be used when they have lost the capacity to participate in the decision-making process.
The ICB’s call is a timely one. At present, in Irish law, the status of such advance directives or living wills is unclear (see Older People in Modern Ireland, pp 89, 130, 141, 151, 162). They are certainly one factor which decision-makers (such as a next-of-kin, medical personnel, and the courts) take into account, but there is in Ireland no equivalent of the UK’s Mental Capacity Act 2005, which from April 2007 will provide for the enforceability of advance directives. Such a development in Ireland would be an excellent complement to the pending Mental Capacity and Guardianship Bill, 2007, and may even find a ready and speedy home in an amendment to that Bill.
The ICB’s call for the introduction of legislation pertaining to living wills is highly significant, given the present lacuna in the law. Advance care planning in the form of living wills furthers the autonomy of the individual, and ensures that her “critical interests” (Dworkin) in determining her future treatment when she is incompetent are respected.
Could I be so bold as to refer people to my article “The Case for Living Wills in Ireland� (2006) 12(1) Medico-Legal Journal of Ireland 5?
This article deals with the situation in other jurisdictions such as the US and the UK, and then focuses on the ethical and moral dilemmas which living wills pose: I look at the conflict between autonomy v best interests in the context of living wills; the issue of whether a competent individual is capable of articulating an informed decision in a living will due to the lack of information/knowledge relating to medical developments and the reality of life as an incompetent person; and the inability of the author to retract her living will when incompetent.
Hi Liz,
Thanks for the reference to the article. I shall read it with interest.