Developing a Legal Framework for Advance Healthcare Planning: Comparing England & Wales and Ireland

In: European Journal of Health Law
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  • 1 University College Cork Law School, Cork, Ireland

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This article examines the legislative frameworks for advance healthcare planning in England & Wales (the Mental Capacity Act 2005) and in Ireland (the Assisted Decision-Making (Capacity) Act 2015), undertaking a comparative analysis of each measure, with particular focus on the detail of the approaches taken. It is only through this kind of detailed focus that the normative choices made by legislation can fully be understood and evaluated. The article argues that, in several respects, possibly because the drafters were able to reflect lessons learned from other jurisdictions, the Assisted Decision-Making (Capacity) Act 2015 provides a more rounded and complete form of advance healthcare planning than that provided by the Mental Capacity Act. This is on the basis that it provides more protection for patient choice; better potential for delivery on the choices made; and a more appropriate balance between formalities and enforceability.

  • 2

    See D. Veshi and G. Neitzke, ‘Advance Directives in Some Western European Countries: A Legal and Ethical Comparison between Spain, France, Italy and Germany’, European Journal of Health Law 22(4) (2015) 321-345; D. Veshi and G. Neitzke, ‘Living Wills in Italy: Ethical and Comparative Law Approaches’, European Journal of Health Law 22(1) (2015) 38-60; M. Navarro-Michel, ‘Advance Directives: The Spanish Perspective’, Medical Law Review 13(2) (2005) 137-169.

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  • 8

    See generally, A. Maclean, ‘Advance Directives, Future Selves and Decision-Making’, Medical Law Review 14(3) (2004) 291-230; P. Lewis, ‘Medical Treatment of Dementia Patients at the End of Life: Can the Law Accommodate the Personal Identity and Welfare Problems’, European Journal of Health Law 13(3) (2006) 219-234.

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  • 9

    Ronald Dworkin, Life’s Dominion: An Argument about Abortion, Euthanasia and Individual Freedom (New York: Alfred A Knopf, 1993), pp. 201-202. Dworkin contrasts a person’s experiential interests with his or her more morally significant ‘critical interests’ which relate to how s/he wishes to live his or her life.

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  • 10

    See e.g., N. Rhoden, ‘Litigating Life and Death’, Harvard Law Review 102(2) (1988) 375-446.

  • 12

    A. Buchanan, ‘Advance Directives and the Personal Identity Problem’, Philosophy and Public Affairs 17(4) (1988) 277-302.

  • 13

    See e.g., R. Dresser, ‘Life, Death and Incompetent Patients: Conceptual Infirmities and Hidden Values in the Law’, Arizona Law Review 28(3) (1986) 373-405; S. Holm, ‘Autonomy, Authenticity or Best Interests: Everyday Decisionmaking and Persons with Dementia’, Medicine, Healthcare and Philosophy 4(2) (2001) 153-159.

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  • 15

    House of Lords Select Committee, Mental Capacity Act 2005: Post Legislative Scrutiny (London: The Stationary Office, 2014), para. 193.

  • 18

    See e.g., W v. M and S and An NHS Primary Care Trust [2011] ewhc 2443 (Fam); Re D [2012] ewcop 885.

  • 38

    See M. Ashby and B. Stoffell, ‘Artificial Hydration and Alimentation at the End of Life: A Reply to Craig’, Journal of Medical Ethics 21 (1995) 135-140.

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  • 40

    See O. O’Neill, Autonomy and Trust in Bioethics (Cambridge: Cambridge University Press, 2002), p. 37.

  • 46

    See C. Lemmens, ‘A New Style of End-of-Life Cases: A Patient’s Right to Demand Treatment or a Physician’s Right to Refuse Treatment? The Futility Debate Revisited’, European Journal of Health Law 20(2) (2013) 167-183 at 181.

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  • 50

    See K. Manson and G. Laurie, ‘Personal Autonomy and the Right to Treatment’, Edinburgh Law Review 9(1) (2004) 123-132.

  • 51

    Select Committee Report, supra note 15, para. 197.

  • 72

    See Heywood, supra note 19, 94.

  • 82

    See A. Maclean, ‘Advance Directives and the Rocky Waters of Anticipatory Decision-Making’, Medical Law Review 16(1) (2008) 1-22, at 20.

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  • 97

    J. Samantha, ‘Lasting Powers of Attorney for Healthcare under the Mental Capacity Act 2005: Enhanced Prospective Self-Determination or a Simulacrum’, Medical Law Review 17(3) (2009) 377-409, at 409.

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  • 98

    See M. Donnelly, ‘Best Interests, Patient Participation and the Mental Capacity Act 2005’, Medical Law Review 17(1) (2009) 1-29, at 29.

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  • 101

    Ibid., 125.

  • 105

    Under the Patient Self-Determination Act 1990.

  • 107

    A. Jones, A. Moss and L. Harris-Kojetin, 2011, ‘Use of Advance Directives in Long Term Care Populations’, United States National Centre for Health Statistics (NCHS) Data Brief 54,, retrieved 23 February 2016. This may be contrasted with 65 per cent of nursing home residents and 28 per cent of home healthcare patients.

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