The introduction of a legal framework for Advance Directives in Irish mental health care

Abstract

Advance directives (ADs) are legal statements or documents, which allow a person to outline treatment preferences and other life choices prior to a mental health crisis. This thesis examines the issues arising in relation to the introduction of a legal framework for ADs in Irish mental health care from an international, comparative and national perspective. Ireland currently lacks legislative provisions for ADs, but it is proposed to incorporate legislative provisions into the Assisted Decision-Making (Capacity) Bill 2013 (2013 Bill) in the near future. This thesis reviews the literature on ADs and considers the legal, ethical and implementation issues associated their use under international, comparative and domestic frameworks and from the perspective of key stakeholders. The views and preferences of Irish stakeholders are addressed through an original empirical study. The international research considers the introduction of ADs under the United Nations Convention on the Rights of Persons with Disabilities (CRPD). The CRPD requires a new approach to decision-making in mental health care and the development of a range of support strategies. The thesis will consider the implications of the CRPD on the conceptual foundation of ADs and their role under new human rights frameworks. The thesis also includes a comparative study into an innovative approach to the implementation of ADs in the State of Virginia in the United States. The aim of the empirical research is to determine the views and preferences of Irish service users and consultant psychiatrists towards the proposed use of ADs and the extent to which they will be supported in Ireland. The empirical research found broad support for ADs among Irish stakeholders, but varying implementation preferences. The research makes recommendations for the introduction and implementation of an appropriate legal framework for mental health ADs in Ireland and other jurisdictions under international human rights frameworks.