Dementia Pathways. For Primary Care in ireland
  • An Advance Healthcare Directive (AHD) allows a person with capacity to write down their preference around healthcare treatment in case they lack capacity in the future.
  • The Advance Healthcare Directive may be a stand-alone directive or the person may appoint a Designated Healthcare Representative to exercise such powers as conferred by the person under the Directive.
  • This document is binding in relation to treatment refusals.
    • Where a patient has documented their preference to refuse a treatment this preference must be followed even where that refusal may appear at the time of its implementation to be unwise, or even where treatment refusal may result in death. 
    • However, the AHD is not applicable to the refusal of life sustaining treatment unless there is a specific statement in the document acknowledging that the person understands that this refusal may result in his/her death.
  • Requests for treatment are not legally binding but must be considered.
  • If a doctor treating the patient fails to comply with a valid and applicable AHD then they have civil and criminal liability, unless the healthcare professional acted in good faith and in accordance with what he/she reasonably believed at the time to be the will and preferences of the patient as expressed in the AHD.


If there is no Advance Healthcare Directive in place and the person has signed an Enduring Power of Attorney then the attorney appointed may have the authority to make the health related decision in question.

The PDF document below produced by the Irish Hospice Foundation gives advice on how healthcare professionals can engage in a discussion on Advance Healthcare Directives with a person with dementia.