Individuals should be allowed to formulate "living wills" in which they set out what medical treatment they do - or do not - wish to receive in the event of their becoming incapacitated, according to a report to be published today.
The Irish Council for Bioethics (ICB) report says individuals should have a right to use such wills, also known as advance healthcare directives, to refuse any form of medical treatment. This includes artificial nutrition and hydration, typically given to individuals in a vegetative state.
However, requests made in such directives must be legal within the jurisdiction where they are drawn up, it says. This means that, barring changes to the law here, an individual would not be allowed to request specific actions which would lead to their death by euthanasia.
The ICB, which is chaired by former attorney general Dermot Gleeson SC, also calls for the development of a legal framework to ensure "living will" directives can be used here. It says a competent individual's advance directive should not be overridden by the wishes of family members.
The only exception should be if this is explicitly allowed for in the directive, or if a "proxy" individual has been nominated.
Similarly, it says an advanced directive should be respected as a "more authoritative expression of an individual's wishes" than any "presumed alteration of the directive as a result of illness -induced personality change." A directive should therefore be respected unless it can be shown by a third party that it is "demonstrably contrary" to the wishes of the incapacitated individual.
In general, the report advocates a combination of a "living will" and the nomination of one or more "proxies", who can make a decision or interpretation based on their judgment of what the author of the will would want.
But the report points out that although the "weight of legal opinion" in the State recognises the right of competent adults to decide on the nature of their medical treatment, there is no specific legislation in regard to advance directives. This makes the status of such directives unclear, meaning their implementation may or may not be enforced, it says.
The report states that healthcare professionals are "not at liberty to judge that a patient's decisions are either incorrect or irrational simply because they are at variance with the professional's opinion or values."
"Nonetheless, the ICB recognises that a competent individual's rights in healthcare decision-making are not absolute and that individuals cannot compel healthcare professionals or other parties to act against their conscience (or the law) to accede to their wishes regarding treatment." The report, which follows an extensive public consultation process, notes that requests not to be placed in a nursing home are one of the most common preferences outlined in advance directives elsewhere.