The Assisted Decision Making Act will commence on April 26^th 2023 and this new law will introduce changes to the way we practice medicine. Among the key changes that will result are:

• the introduction of a tiered system of statutory roles to support individuals who may require assistance in making decisions including consent for medical treatment
• these new roles will replace the existing system of wards of court
• the Act sets out a statutory basis for Advanced Healthcare Directives
• the decision support roles will fall under the governance of a new statutory agency the Decision Support Service

The Act defines in law that a person’s capacity to make a specific decision includes an assessment of their ability to:

• understand information and facts relevant to the decision;
• retain that information long enough to make a voluntary choice;
• use or weigh up that information as part of the process of making the decision; and
• communicate the decision by any means, including by assistive technology

The decision support roles defined in the Act include:

• decision making assistant
• co-decision-maker
• decision-making representative (which must be approved by the circuit court)
• attorney (power of attorney)
• designated healthcare representative

Only an approved decision-making representative or a designated healthcare representative may consent to medical treatment (including surgical procedures) on behalf of any individual. It is important to know that neither those with Power of Attorney or “next of kin” have any status in consent to treatment. Decision supporters have a role in supporting individuals to make a wide range of decisions and are not just limited to healthcare.

Patients may now make a legally binding Advanced Healthcare Directive in which they set out their healthcare preferences should they be unable to express their preferences at some point in the future. Patients may set out treatments they do not wish to have (but cannot decline basic life sustaining care) which are legally binding and they may also express their wishes regarding treatments they would like to have (but these are not legally binding). Patients may nominate a designated healthcare representative to make healthcare decisions on their behalf but the representative may not overrule the will and preference of the patient as set out in their advanced healthcare directive.

Training and support material: The HSE have developed a comprehensive range of training courses and videos that will help you prepare for the implementation of the new legislation and the changes in clinical practice that will be required. The HSE have a wide range of support materials available on a new dedicated website www.assisteddecisionmaking.ie. Training materials are also available to HSE employees on the e-learning platform www.HSEland.ie

Decision Support Service: The Decision Support Service https://www.decisionsupportservice.ie/ have developed a series of codes of practice including ones specific to healthcare professionals which will be published on their website as soon as they received ministerial approval. They also have training materials and other resources for the public, healthcare providers and other professionals.

RCSI are in the process of updating our Code of Practice for Surgeons (2018) to reflect these new legislative changes and we hope to publish the updated Code of Practice by the summer of 2023. The new statutory requirements will be included in our trainee teaching curriculum and CPD_SS programme over the coming year.

The HSE National Office of Human Rights and Equality Policy and HSE Strategy and Research  are running a webinar entitled “Getting ready for Advance Healthcare Directives under the Assisted Decision-Making (Capacity) Act 2015”  on

Date & time: Wednesday 29th March 2023 5:30-7pm.

Registration: Please follow the link: https://us06web.zoom.us/webinar/register/WN_nQeR59i_RNC_3ZBnbGggvQ

This webinar is aimed at all healthcare workers, in particular clinicians, and will give an overview of Advance Healthcare Directives, with focus on some practical, legal, mental health service and personal considerations along with information about the Decision Support Service Codes of Practice relating to Advance Healthcare Directives.

The objectives of the webinar are to:

• stimulate discussion about the legal and practical considerations for Advance Healthcare Directives
• provide guidance on Advance Healthcare Directives to services and practitioners
• support staff development and learning on Advance Healthcare Directives.

The event will be chaired by Dr. Siobhán Ni Bhriain, HSE National Clinical Director Integrated Care.

Speakers and Panel includes:

• Prof. Mary Donnelly, School of Law UCC and Co-Chair of the HSE ADM Steering Group
• Prof. Shaun O’Keeffe, Consultant Geriatrician, University Hospital Galway and Co-Chair of the HSE ADM Steering Group
• Ms Áine Flynn, Director of the Decision Support Service
• Prof. Brendan Kelly, Professor of Psychiatry, Trinity College Dublin
• Ms Joanne Condon, Acting National Manager, National Advocacy Service for People with Disabilities.