The Assisted Decision-Making (Capacity) Act 2015: what it is and why it matters

Kelly, Brendan D.

doi:10.1007/s11845-016-1443-5

Cited by 36 publications

(27 citation statements)

References 5 publications

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“…Although AHDs are not generally legally binding documents (Duffy & Kelly, ; National Gold Standards Framework Centre, ; Sudore et al, ), they are important and should be considered in the decision‐making processes. They contain the will and preferences of persons‐in‐care, particularly concerning treatment decisions that may arise that will affect them directly although they temporarily lack the capacity (construed functionally) at a time when making or communicating a decision is required (Kelly, ). The AHD content, open and flexible, enables their preferences regarding crisis intervention, treatments and clinical procedures to reduce or improve symptoms to be registered, all within a framework of good healthcare practice.…”

Section: Introductionmentioning

confidence: 99%

Advance healthcare directives in mental health: A qualitative analysis from a Spanish healthcare professional's viewpoint

Juliá‐Sanchis

García-Sanjuán

Martí

et al. 2019

Psychiatric Ment Health Nurs

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Accessible summary What is known on the subject? Advance care planning (ACP) in mental health is a useful tool to avoid human rights violations in mental health settings. However, ACP is not yet a reality in the Spanish context. The advance healthcare directive (AHD) is a document reflecting healthcare preferences, drafted within the framework of the ACP process, to be applied in situations in which an individual's legal capacity may be questionable. No study has explored the viewpoint of Spanish mental healthcare professionals towards AHDs in the mental health field. Considering their extensive use, further study of providers’ knowledge and attitudes is warranted. What does the paper add to existing knowledge? The study adds knowledge about the viewpoint of Spanish mental healthcare professionals towards the implementation of AHDs in their clinical practices. This study illuminates the prevailing paternalistic provider–user relationship as the main barrier surrounding AHD management in terms of decision‐making. Our findings support the need for broader awareness, staff training regarding the documentation, the conversation process and communication skills, and personalized assistance in the mental health services to implement AHDs in everyday practice. What are the implications for practice? Advance healthcare directives are a recovery tool that offers major information regarding mental health user preferences. Although they pose challenges for clinical practice, AHDs should be incorporated into interventional mental health care. Obtaining up‐to‐date perspectives held by mental healthcare professionals regarding AHDs allows the administration to determine the aspects requiring reinforcement. The implementation of AHDs in the Spanish mental health system requires macro‐ and micro‐changes, both ethically and structurally, so that mental healthcare professionals relinquish their paternalistic approach and embrace new ways of relating to users. AbstractIntroductionAn advance healthcare directive (AHD) is a written document that contains a patient‐in‐care's will and preferences concerning the treatment options available to them, should they lack decision‐making capacity. AHDs are completed within a broader framework known as advance care planning. No study has explored the viewpoint of Spanish mental healthcare professionals towards AHDs.AimTo explore the viewpoint of mental health professionals towards the implementation of AHDs in mental health.MethodA qualitative study was conducted using semi‐structured interviews that were thematically analysed.FindingsThree main themes were identified: care planning culture; barriers for the practical management of AHDs; and reasons to not honour patient‐in‐care AHDs.DiscussionProfessionals find it pragmatically difficult to stop applying traditional paternalistic practices. To implement AHDs, improving the knowledge and awareness of AHDs and management of non‐technical skills through training is required. Such training should include users and families and allow fo...

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Section: Introductionmentioning

confidence: 99%

Advance healthcare directives in mental health: A qualitative analysis from a Spanish healthcare professional's viewpoint

Juliá‐Sanchis

García-Sanjuán

Martí

et al. 2019

Psychiatric Ment Health Nurs

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“…The issue of assessing a person's mental capacity is a concern among health care professionals across the literature, and the research fails to reach consensus about who exactly must take responsibility for capacity when it comes to advance care planning (Chan et al., 2018; Gilissen et al., 2017; Kelly, 2017; Miller, 2017; Rietjens et al., 2017; Robinson et al., 2013). While Ireland still awaits Codes of Practice covering the specific provisions of the (2015) Act, the specific identity of ‘health care professional’ mentioned in the legislation in Ireland remains elusive (Kelly, 2017). Interestingly, in Robinson et al.…”

Section: Capacity—what It Is and Who Decides?mentioning

confidence: 99%

“…However, in considering the low take‐up rates for advance directives, Sampson et al. 's (2010) study does add the caveat that many people simply do not want to plan for death, preferring to live in denial, or to take ‘one day at a time’, a view echoed in the wider literature (Bond & Lowton, 2011; Fried & Drickamer, 2010; Kelly, 2017; Son et al., 2020; Zimmerman, 2007). Conversely, Poppe et al.…”

Section: Time To Decidementioning

confidence: 99%

“…The Irish Assisted Decision‐Making (Capacity) Act (2015) provides that an advance health care directive allows a person to set down in advance their refusal of particular medical treatment; this is legally binding and must be upheld, even in the face of family or caregiver disapproval or disagreement, or an ‘unwise’ decision (Kelly, 2017).…”

Section: Introductionmentioning

confidence: 99%

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Implementing advance directives—An international literature review of important considerations for nurses

2020

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Aim(s) To review the global literature on the implementation of advance health care directives to date, and the experiences of the health care professionals who must initiate the discussions around advance care planning, as well as support patients' ultimate decisions. Background Ireland's Assisted Decision‐Making (Capacity) Act 2015 legalizes advance health care directives. It promotes the autonomy of the person and enables them to have treatment in accordance with their will and preferences. However, there is professional uncertainty on how to support and integrate assisted decision‐making. Evaluation 16 studies featuring the views of health care professionals are included and evaluated using a framework of ‘benefits versus challenges’. Key issue(s) Four themes clearly emerge during the review process: the concept of capacity and who decides; autonomy versus paternalism—conflict among the health care professional/patient/family caregiver triad; barriers to advance directives; and timing issues. Conclusion(s) Significant benefits of advance health care directives exist for all parties including less stress for patients and families alike, less burden and less residual guilt for surviving relatives, and an over‐arching prevention of ‘crisis’ decision‐making. Implications for Nursing Management This review highlights the central role of the nurse in empowering patients to express their wills and preferences, supporting patients' capacity to make decisions about their own care, initiating end‐of‐life care discussions and advocating to have advance health care directives acknowledged. Moreover, it identifies the challenges ahead for all nurse managers in implementing this new mandate.

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“…Autonomy, flexibility and communication are key elements of personhood that are currently absent on a day-to-day basis in home care provision. Given Ireland's new Assisted Decision Making Act (2015), which places the will and preferences of people with impaired mental capacity at the heart of decision making for both their personal welfare and their property and affairs (Kelly, 2017); the absence of recognition of the autonomy rights of the individual and the lack of choice available to families in relation to service supports warrants urgent attention.…”

Section: Current Gapsmentioning

confidence: 99%

Developing and implementing dementia policy in ireland

Human Rights Documents Online

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Historically, dementia care in Ireland has been under-funded and under-prioritised (Cahill, 2010). The care system has slowly moved away from institutionalisation, workhouses for the destitute and large-scale unregulated county homes to newer more enlightened models with a stronger focus on community care (Timonen and Doyle, 2008). The Care of the Aged Report (Inter-Departmental Committee on the Care of the Aged, 1968), was the first policy document that explicitly referenced older people remaining in their own homes. These commitments to community care were magnified in The Years Ahead: a Policy for the Elderly (Robins, 1988). The Years Ahead also contained some of the first dementia specific policy recommendations. These centred on elements such as screening for dementia, the need for dementiaspecific carers, additional day care and day hospital facilities, specialist hostels to support people with severe dementia and developing the provision of psychiatry in old age. Although clinically driven these policy documents have provided a solid baseline for current developments in dementia services. An Action Plan for Dementia (O'Shea and O'Reilly, 1999) commissioned by the National Council for Ageing and Older People, was Ireland's first non-governmental dementia plan. It envisioned a person-centred, best practice social model of dementia care highlighting the need for major improvements in care in the community. It prioritised several key areas: increased public awareness, earlier diagnosis, psychosocial approaches to complement existing care, community based-services and small-scale residential care units. The government's 2001 Health Strategy (Dept. of Health, 2001) pledged to implement the Plan, but this hope was never realised. Despite pressure from various stakeholder groups, the setting up of two National Dementia Working Groups and the publication of a call for implementation (O'Shea, 2007) dementia failed to become a priority for government. The attention of policymakers at that time was focused mainly on the regulation of nursing homes in Ireland, including establishing the statutory provision of long-term care with the Nursing Homes Act (1990) and the development of national quality standards for residential care settings for older people in Ireland (HIQA, 2008). Eventually, in 2011 a promise was given by the incoming government to develop a National Dementia Strategy (Dept. of Health, 2014). However this was signalled as a no cost strategy, due to the precarious condition of the State's finances at that time. Fortunately, from 2011 to 2016, dementia care in Ireland benefited from a substantial charitable investment of over €33 million from The Atlantic Philanthropies (O'Shea and Carney, 2016). Atlantic Philanthropies funded major multi-sectoral programmes throughout the country in key areas such as: service transformation, including end-of-life care; advocacy and awareness; education and training; brain health, prevention and diagnosis; and measurement, research and evaluation (O'Shea and Carney, 2016). ...

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The Assisted Decision-Making (Capacity) Act 2015: what it is and why it matters

Cited by 36 publications

References 5 publications

Advance healthcare directives in mental health: A qualitative analysis from a Spanish healthcare professional's viewpoint

Advance healthcare directives in mental health: A qualitative analysis from a Spanish healthcare professional's viewpoint

Implementing advance directives—An international literature review of important considerations for nurses

Developing and implementing dementia policy in ireland

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