Advance Care Planning & Advance Healthcare Directives November 2017 Deirdre Shanagher Title slide. Image needed?

Today: Advance Care Planning (ACP) Some guidance Advance Healthcare Directives (AHD) Questions

Have you thought about it? What would you want?

Advance Care Planning –What is it? Voluntary discussions over time about future care Process not task – may be more than one conversation When we know things may change When we know decision making in the future may be difficult

What might be included in ACP discussions Symptom control Physical Psycho-social Spiritual Financial Oct 30th 09 ST/AON

What might be discussed (medical)? Use of preventive health screenings, medications and dietary restrictions, invasive medical procedures and tests Hospitalization Use of intensive care units and ventilators Artificial nutrition/hydration Use of antibiotics Cardiopulmonary resuscitation Making advance healthcare directive

Guidance for healthcare professionals: Always presume decision making capacity Help the person to maximise their decision making capacity Remember that the person with dementia can choose not to take part in the advance care planning process Be aware of how to assess a persons decision making capacity if required to do so Gain knowledge on what steps to take if decision making capacity is an issue Check existing advance care plans with the person regularly for validity and applicability Presuming covered under the functional approach to capacity

If decision-making capacity is an issue: Support the person to be involved in the decision-making process by engaging in capacity building and maximising. Consider the level of support that the person requires to make the decision in question. Seek evidence of previously expressed preferences. Consider which option, including not to treat, would be least restrictive of the person’s future choices. Consider the views of anyone indicated by the person. These people may be those appointed by the person to support them when making decisions. A Consider involving advocacy support. If there is nobody appointed by the person whose decision making capacity is at issue and/or an urgent decision is required, an application can be brought to the circuit court seeking the appointment of one or more persons to act as a decision making representative.

How do we start? Have you ever heard of the Think Ahead Initiative? Have you ever heard of an advance healthcare directive Have you ever talked to anyone about what you would or wouldn’t want if something unexpected happened. Sometimes people like to write things down/make what’s called an advance healthcare directive Do you have any worries or wishes about your future care/health care? Is there anything that you’d like to tell us about supporting you in the future? Have you ever heard of the Think Ahead Initiative? Have you ever thought about what you might want if you became very unwell…?

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 responsible for commencing most of the Act Minister for Health responsible for commencing the AHD section Re codes of practice: Will & Preferences Least restrictive Proportionate Limited in duration Take into account beliefs and values

Where we are now. Phased commencement Decision Support Service(DSS) is to be established Aine Flynn appointed as Director and took up post on Oct 2nd Codes of practice to be developed AHD multidisciplinary working group established (prepare recommendations for code of practice for AHDs)

Advance Healthcare Directives: A document where a person can write down what they would not 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. The difference between an ACP and AHD is the refusal and legal binding with refusing treatments.

Think Ahead form Includes an advance care directive compliant with the new legislation Broader than healthcare

Think Ahead form Think Talk Tell Record Review Sections: Key Information Care Preferences (AHD and emergency summary form) 3. Legal 4. Financial 5. When I Die Submissions to the forum indicated wanting info on handling financial affairs and speaks to Prevention of Elder abuse You don’t have to complete all of the document

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Deirdre Shanagher Deirdre.shanagher@hospicefoundation.ie I’d like to acknowledge these people and will now take some questions if there are any.