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Change due on decision-making with start of new Act

04 Mar 2016

PIc: Getty Images

Procedures related to the decision-making process of incapacitated adults are due to change with the commencement of the new Assisted Decision Making Act.

Inclusion of those who had a close, ongoing, personal relationship with the service user — in particular anyone chosen by the service user to be involved in treatment decisions — in the discussion and decision-making process pertaining to health and social care interventions, may be useful, the HSE said.

Their role in such situations is not to make the final decision, but rather to provide greater insight into service users previously expressed views and preferences and to outline what they believe the individual would have wanted. In some cases, involvement of those close to the service user will facilitate the service user in reaching a decision in conjunction with health/social care providers.

There is currently no legislative framework to govern how a decision about treatment and care should be made for those who lack capacity to make that decision themselves. However, Irish case law, national and international guidelines suggest that in making decisions for those who lack capacity, the health and social care professional should determine what is in their best interests, which is decided by reference to their values and preferences if known. The HSE’s current position in relation to valid and genuine consent is outlined in the National Consent Policy.

There are a number of steps outlined in the policy document to guide healthcare professionals in making their decision on the service user’s best interests, the HSE said. The policy is underpinned by principles of effective communication and consultation with those close to the adult service user who lacks capacity to make decision for themselves with a view to understanding the service user’s preferences.

No other person such as a family member, friend or carer and no organisation can give or refuse consent to a health or social care service on behalf of an adult service user who lacks capacity to consent unless they have specific legal authority to do so.

The implementation of the policy is the responsibility of the health and social services providers.

Gary Culliton

Click here to view the full article which appeared in Irish Medical Times