Advance Healthcare Directives: Friend or Foe?

Objectives - This thesis proposes the question, Advance Healthcare Directives – Friend or Foe? Is it a good thing or a bad thing to have an advance healthcare directive?

Ethical and legal considerations - I introduce the concept of an advance healthcare directive and why they developed. They started in the US where they are called ‘living wills’. They aim to promote patient autonomy and self determination in advance of the loss of capacity. Ethical arguments about making decisions for a ‘future self’ have been balanced with legal arguments for PVS patients being allowed to die by refusing treatments. I have shown that there may be many obstacles and barriers to the implementation of advance healthcare directives. By using the internet with websites to provide information and guidance in preparing an advance healthcare directive, more and more people are becoming aware of them. New procedures, guidelines and laws have allowed more protection for vulnerable patients while at the same time promoting advance healthcare directives as a means of extending patient autonomy into the future.

Conclusion – Many of the initial problems of advanced care directives have been recognised and addressed in various guides and laws from the US and UK. Here in Ireland we still lag behind in the distribution of information and raising public awareness around the whole topic of death and dying but especially in this aspect of preparing an advance healthcare directive. Legally binding instruments may make preparing an advance healthcare directive more cumbersome but they allow for greater certainty that the advance healthcare directive will be judged valid and applicable and thus implementing the patients’ decisions. I conclude that advance healthcare directives are our friends, though as in any good relationship, it may be a bit complex at times but it is worth the effort.