Wednesday, November 25, 2009

Response to the Irish Law Reform Commission’s report on Advance Care Directives

The Irish Government in September 2008 published an outline for a mental capacity bill and this was followed earlier this year by the law reform commission report on advance care directives.

An analysis of the Law reform Commission proposals carried out by the Southern Cross Bioethics Institute warns about the dangers of advance care directives as evidenced in other jurisdictions. We include below some of their comments.

Advance care directives are an ethically flawed and potentially dangerous response to the problem of patient fears regarding end of life treatment and care.

• Advance care directives rely on an exaggerated view of patient autonomy, encouraging patients to make life and death decisions outside of a healthcare setting.

• This means that patients are encouraged to make decisions:
o without the benefit of medical advice,
o without assessment of their capacity to make such decisions,
o without protection from the influence or coercion of third parties,
o and without subjective experience of pain and other symptoms that future medical treatment might address.

Advance care directives are therefore in contravention of the principle of informed consent.

The bottom line is that:
• The principles and practice of good medical decision-making in the best interests of the patient are the best response to advance care directives, and to the original problem of patient fears about end-of-life treatment.
• The draft bill should be opposed.
• If it cannot be defeated, the draft bill should be amended in significant ways

The full executive summary and complete report can be viewed on the European Life Network website