THE ASSISTED DECISION MAKING (CAPACITY) ACT 2015

Deirdre Shanagher, Marie Lynch, Dr John Weafer, Prof Willie Molloy, Dr Sharon Beatty, Dr Geraldine McCarthy, Patricia

Rickard-Clarke, Emer Begley, Esther Beck, Sarah Murphy

AOTI Day, Athlone, March, 2016

Today:• The legislation – useful facts

• Key considerations to inform good practice

• Functional approach to capacity

• Advance healthcare directives

• Guidance for healthcare staff

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 will commence most of the Act• Minister for Health will commence the AHD section

Key considerations to inform good practice:

1. Recognise that under Human rights legislation everyone has the right to make their own decisions.

2. Develop understanding of advance care planning3. Become familiar with aspects of the Assisted Decision

Making (Capacity) Act 2015, specifically in relation to:• The Functional approach to capacity • Advance healthcare directives

Functional Approach to Capacity:• Presumption of Capacity

• Understand• Retain• Weigh• Communicate

Advance Healthcare Directives:

• A document where a person can write down what they would 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).

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.

Guidance for healthcare professionals:• Presuming decision-making capacity

• Maximising decision-making capacity

• Assessing decision making capacity

• Making decisions if decision-making capacity is an issue

Maximising decision-making capacity:• Discuss treatment options in a place and at a time when the

person is best able to understand and retain information.• Ask the person if there is anything that would help them

remember information or make it easier to make a decision; such as:• Bringing another person to healthcare meetings or • Having audio or pictorial information about their condition • Writing things down • Using simple language• Finding out how the person usually communicates• Giving the person space to think quietly• Involving others where necessary such as speech and language

therapists or psychologists

Assessing decision-making capacity:• Consider what decision has to be made

• Do not discriminate

• Is there something currently happening that may temporarily affect the person’s decision-making capacity

• Consider what supports have been provided

• Consider if decision-making capacity is absent even with all practicable support

Assessing decision-making capacity:• Can the person:• Understand information relative to the decision

• Retain the information long enough to make a voluntary choice

• Use or weigh the information as part of the process of making the decision

• Communicate their decision?

If decision-making capacity is an issue:1. Support the person to be involved in the

decision-making process by engaging in capacity building and maximising.

2. Consider the level of support that the person requires to make the decision in question.

3. Seek evidence of previously expressed preferences.

4. Consider which option, including not to treat, would be least restrictive of the person’s future choices.

5. Consider the views of anyone indicated by the person. These people may be those appointed by the person to support them when making decisions.

6. A Consider involving advocacy support.

Advance Care planning:

IHF Dementia Guidance Documents

Public Consultation

April 4th

Acknowledgements

Thank you and QuestionsFor more information:

Deirdre ShanagherDeirdre.shanagher@hospicefoundation.ie

People with dementia and carers who have contributed and advised IHF

IHF Changing Minds Team Project and Expert Advisory and

Governance Groups Atlantic Philanthropies