1. Advance Care Planning & Advance Healthcare Directives
November Deirdre Shanagher
Title slide. Image needed?

2. Today: Advance Care Planning (ACP) Some guidance
Advance Healthcare Directives (AHD)
Questions

3. Have you thought about it?
What would you want?

6. Advance Care Planning –What is it?
Voluntary discussions over time about future care
Process not task – may be more than one conversation
When we know things may change
When we know decision making in the
future may be difficult

7. What might be included in ACP discussions
Symptom control
Physical
Psycho-social
Spiritual
Financial
Oct 30th 09
ST/AON

8. What might be discussed (medical)?
Use of preventive health screenings, medications and dietary restrictions, invasive medical procedures and tests
Hospitalization
Use of intensive care units and ventilators
Artificial nutrition/hydration
Use of antibiotics
Cardiopulmonary resuscitation
Making advance healthcare directive

9. Guidance for healthcare professionals:
Always presume decision making capacity
Help the person to maximise their decision making capacity
Remember that the person with dementia can choose not to take part in the advance care planning process
Be aware of how to assess a persons decision making capacity if required to do so
Gain knowledge on what steps to take if decision making capacity is an issue
Check existing advance care plans with the person regularly for validity and applicability
Presuming covered under the functional approach to capacity

10. If decision-making capacity is an issue:
Support the person to be involved in the decision-making process by engaging in capacity building and maximising.
Consider the level of support that the person requires to make the decision in question.
Seek evidence of previously expressed preferences.
Consider which option, including not to treat, would be least restrictive of the person’s future choices.
Consider the views of anyone indicated by the person. These people may be those appointed by the person to support them when making decisions.
A Consider involving advocacy support.
If there is nobody appointed by the person whose decision making capacity is at issue and/or an urgent decision is required, an application can be brought to the circuit court seeking the appointment of one or more persons to act as a decision making representative.

11. How do we start? Have you ever heard of the Think Ahead Initiative?
Have you ever heard of an advance healthcare directive
Have you ever talked to anyone about what you would or wouldn’t want if something unexpected happened. Sometimes people like to write things down/make what’s called an advance healthcare directive
Do you have any worries or wishes about your future care/health care?
Is there anything that you’d like to tell us about supporting you in the future?
Have you ever
heard of the
Think Ahead
Initiative?
Have you ever thought about what you might want if you became very unwell…?

13. 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 responsible for commencing most of the Act
Minister for Health responsible for commencing the AHD section
Re codes of practice:
Will & Preferences
Least restrictive
Proportionate
Limited in duration
Take into account beliefs and values

14. Where we are now. Phased commencement
Decision Support Service(DSS) is to be established
Aine Flynn appointed as Director and took up post on Oct 2nd
Codes of practice to be developed
AHD multidisciplinary working group established (prepare recommendations for code of practice for AHDs)

15. 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).

16. 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.
The difference between an ACP and AHD is the refusal and legal binding with refusing treatments.

17. Think Ahead form
Includes an advance care directive compliant with the new legislation
Broader than healthcare

18. Think Ahead form Think Talk Tell Record Review Sections:
Key Information
Care Preferences (AHD
and emergency summary
form)
3. Legal
4. Financial
5. When I Die
Submissions to the forum indicated wanting info on handling financial affairs and speaks to Prevention of Elder abuse
You don’t have to complete all of the document

20. Video

21. Deirdre Shanagher Deirdre.shanagher@hospicefoundation.ie
I’d like to acknowledge these people and will now take some questions if there are any.