Nobody enjoys thinking about a time when they might not be able to make their own decisions. But planning ahead — while you’re well and clear-headed — is one of the most empowering things you can do for yourself and the people who care about you. In Ireland, the law now gives you a formal way to do exactly that: an Advance Healthcare Directive.
TL;DR
- An Advance Healthcare Directive (AHD) lets you set out your healthcare wishes in case you lose capacity to make decisions
- AHDs have full legal standing in Ireland under the Assisted Decision-Making (Capacity) Act 2015
- You can refuse specific treatments, express preferences for care settings, and appoint a designated healthcare representative
- You must be 18+ and have capacity when creating your directive — no solicitor is required, but witnesses are
- The Decision Support Service (DSS) maintains a register where you can lodge your directive for safekeeping
What Is an Advance Healthcare Directive?
An Advance Healthcare Directive (sometimes called a “living will”) is a written statement you make now about the healthcare treatments you would or would not want in the future — specifically in situations where you can no longer communicate your wishes. This might be due to a serious illness, an accident, or a condition like dementia.
Since the commencement of the Assisted Decision-Making (Capacity) Act 2015 (as amended in 2022), AHDs have full legal force in Ireland. Healthcare professionals are legally obliged to respect a valid directive, even if they personally disagree with the choices expressed in it.
This isn’t about giving up control. It’s about keeping it.
What Can You Include?
Your directive can cover a wide range of healthcare decisions. Common things people address include:
- Refusal of specific treatments — for example, CPR, ventilation, artificial nutrition, or certain medications
- Preferences for care settings — whether you’d prefer to be cared for at home, in a hospice, or in hospital
- Pain management wishes — your preferences around palliative care and comfort measures
- Organ donation — your wishes regarding donation after death
- General values and beliefs — anything that helps healthcare professionals understand what matters to you
It’s worth knowing that a directive can only refuse treatment — it cannot demand a treatment that a doctor considers clinically inappropriate. However, your stated preferences carry significant weight and must be taken into account.
Who Can Make One?
Any person aged 18 or over who has the mental capacity to understand the nature and consequences of the directive can make one. You don’t need a solicitor, though some people find it helpful to get legal advice, particularly around complex medical scenarios.
The key requirements are:
- You must make it voluntarily, without pressure from anyone
- You must have capacity at the time of making it (you understand what you’re agreeing to)
- It must be in writing and signed by you
- It must be witnessed by at least one person (who is not a spouse, partner, or someone who would benefit from your estate)
Appointing a Designated Healthcare Representative
One of the most useful parts of the law is the option to appoint a Designated Healthcare Representative (DHR). This is a person you trust to ensure your directive is followed and to make healthcare decisions on your behalf in situations your directive doesn’t specifically cover.
Your DHR doesn’t replace your directive — they work alongside it. They act as your voice when you can’t speak for yourself, interpreting your known wishes and values in situations that might not have been foreseeable when you wrote the directive.
To appoint a DHR, you need to include their details in your directive, and they must agree to the role in writing. It’s a significant responsibility, so choose someone you trust deeply and have an honest conversation with them about your wishes.
The Decision Support Service
The Decision Support Service (DSS), part of the Mental Health Commission, oversees the framework around capacity and decision-making in Ireland. They maintain a register where you can lodge your AHD, ensuring it’s accessible to healthcare professionals when needed.
Registering your directive isn’t mandatory, but it’s strongly recommended. A directive that nobody can find when it’s needed is, practically speaking, no directive at all. You can register through the DSS website at decisionsupportservice.ie.
Keep copies with your GP, your designated healthcare representative, and a trusted family member. Let people know it exists.
Having the Conversation
The legal document matters, but the conversation around it matters just as much. Many families in Ireland still find it difficult to talk about end-of-life care. There’s a cultural tendency to avoid the topic — “we’ll cross that bridge when we come to it.”
The trouble is, by the time you reach the bridge, you may not be able to cross it yourself.
Starting the conversation doesn’t have to be dramatic. Some approaches that work:
- Use a prompt. A news story, a friend’s experience, or even reading this article can open the door naturally
- Start with your own wishes. Rather than asking “what would you want?”, share what you would want — it gives others permission to open up
- Keep it practical. Frame it around planning and paperwork rather than illness and death
- Revisit it. One conversation is rarely enough. People’s views change over time, and that’s completely normal
Can You Change Your Mind?
Absolutely. You can update or revoke your directive at any time, as long as you still have capacity. Your views may evolve as your circumstances change — a diagnosis, a life event, or simply a shift in perspective. The directive should always reflect your current wishes.
If you make changes, ensure the updated version reaches everyone who holds a copy: your GP, your DHR, the DSS register, and any family members who are aware of it.
Where to Get Help
If you’re thinking about creating an Advance Healthcare Directive, these resources can help:
- Decision Support Service — decisionsupportservice.ie — information, forms, and the national register
- Your GP — a good first conversation, especially around medical specifics
- Age Action Ireland — information and advocacy for older adults’ rights
- Citizens Information — citizensinformation.ie — plain-language guides to your legal rights
- FLAC (Free Legal Advice Centres) — free legal advice if you need help understanding the legal aspects
Planning ahead isn’t pessimistic — it’s practical, it’s kind, and it’s one of the most thoughtful things you can do for the people around you. At Críonna Health, we believe that informed decisions made in good time are at the heart of ageing well.
📷 Photo by Centre for Ageing Better on Unsplash
