Advance Healthcare Directives in Ireland: How to Make One That Works

An Advance Healthcare Directive is a legal document that lets you specify, in writing, what medical treatment you want — or refuse — if you later lose the capacity to make or communicate decisions. In Ireland it is governed by the Assisted Decision-Making (Capacity) Act 2015, which came into full effect in April 2023.

Getting the document right matters. An AHD that is improperly witnessed, stored where no one can find it, or left undiscussed with healthcare providers may not protect you when it matters most.

What an Advance Healthcare Directive Can and Cannot Do

What it can do:

• Refuse specific life-sustaining treatments, including CPR, mechanical ventilation, artificial nutrition and hydration, and dialysis.
• Express preferences about palliative care, pain management, and the setting in which you wish to die.
• Name a Designated Healthcare Representative (DHR) — a trusted person who can make certain healthcare decisions on your behalf and advocate for your wishes when you cannot speak for yourself.
• Express personal and religious values that should guide healthcare decisions in circumstances not specifically anticipated.

What it cannot do:

• Request treatments that are illegal in Ireland, or demand treatments that a healthcare professional considers clinically inappropriate.
• Override a clinical assessment that a specific treatment would cause more harm than benefit.
• Continue to operate after you die. Authority under an AHD and any Enduring Power of Attorney ceases at the moment of death. From that point, authority passes to the executor named in the will, or to the next of kin.
• Control funeral or burial arrangements. Post-death preferences expressed in an AHD have no legal force over the executor's decisions, though they may be respected as an expression of wishes.

Who Can Make an Advance Healthcare Directive in Ireland?

You must be:

• 18 years or older.
• Capable of understanding the nature and consequences of the decisions you are making at the time you write the directive.

You do not have to be terminally ill, elderly, or facing an imminent medical crisis to make an AHD. Making one while you are in good health, with full capacity to reflect on your values, is far better than trying to draft one in a hospital under pressure.

The Witnessing Rules

An AHD must be signed in writing and witnessed by two adults. Both witnesses must:

• Be 18 or older.
• Be present when you sign.
• Sign the document themselves in your presence.

At least one witness must not be a family member. The idea is to ensure the directive reflects your own autonomous decision-making rather than being produced under family pressure.

Additional restrictions: your Designated Healthcare Representative cannot act as a witness. Neither can a registered healthcare professional involved in your direct care at the time you are making the directive, if you are in a clinical setting.

There is no notarial requirement — you do not need to have the document certified by a commissioner for oaths or a solicitor. However, some people choose to involve a solicitor to ensure the wording is legally unambiguous, particularly when refusing treatment in complex circumstances.

There Is No State Registry

This is the detail that causes the most problems. Unlike the Land Registry or the Probate Office, Ireland has no official state registry for Advance Healthcare Directives. There is nowhere to file or deposit the document with a government body.

This means the burden of ensuring the AHD can be found when it is needed falls entirely on you and your family. An AHD locked in a safe deposit box is functionally useless if a healthcare team is making urgent treatment decisions in an ICU.

Practical steps to ensure your AHD is found:

1. Give the original document or a certified copy to your GP and ask them to attach it to your medical records.
2. Give a copy to your Designated Healthcare Representative and ensure they know their role.
3. Give a copy to any specialist treating you for an ongoing condition.
4. Store a copy with your will and other important documents at home. Tell a trusted family member where it is.
5. Carry a wallet card or note on your phone indicating that an AHD exists and where it can be found.
6. If you are admitted to hospital for any reason, tell the admitting staff that an AHD exists.

Enduring Power of Attorney and the Healthcare Dimension

An Enduring Power of Attorney (EPA) is a related but separate legal instrument. An EPA lets you appoint one or more attorneys to make decisions on your behalf — about personal welfare (including healthcare), property, or both — if you lose capacity.

There is an important legal change that many families miss: EPAs created on or after 26 April 2023 must be registered with the Decision Support Service (DSS) within three months of their creation. Failure to register within that window risks the DSS rejecting the application, which can leave the EPA unenforceable at the exact moment capacity is lost.

EPAs created before 26 April 2023 under the older Powers of Attorney Act 1996 do not need to be registered with the DSS immediately — they are registered with the Wards of Court when the donor loses capacity. However, the transition rules are not simple, and if you have an older EPA you have not used, taking legal advice on whether it needs to be updated is prudent.

A key difference from an AHD: an EPA requires the DSS registration process, involves formal notice requirements, and carries its own prescribed forms available on the Decision Support Service's MyDSS portal. An AHD does not need any registration.

The two instruments can complement each other: the AHD sets out treatment preferences in your own words; the EPA appoints someone you trust to navigate situations the AHD did not specifically anticipate.

What Happens to the AHD When You Die?

Nothing. The AHD ceases to have any legal effect at the moment of death. The Assisted Decision-Making (Capacity) Act is concerned with capacity and living decisions; it does not govern post-death arrangements.

After death, authority over the body and the estate transfers immediately to the executor named in the will (even before a Grant of Probate is extracted), or to the nearest next of kin under intestacy rules if there is no will. Any funeral, burial, or cremation preferences you may have expressed in your AHD carry moral weight but no legal force over that person's decisions.

If you want your post-death wishes to carry legal weight, you should express them in your will, in a prepaid funeral plan, or through a separate written letter of wishes to your executor — not in an AHD.

The AHD in the Broader End-of-Life Plan

An Advance Healthcare Directive is one component of a complete end-of-life planning framework. Together with an EPA, an up-to-date will, and an executor who understands their role, it gives both you and your family legal clarity at the moments when emotions run highest and time is shortest.

The Ireland Funeral Laws & Consumer Rights Guide covers what happens in the period immediately after death in detail — including who has legal authority over the body, how the executor exercises that authority even if family members disagree, and how to navigate the first 72 hours of administration while managing coroner notifications, funeral directors, and frozen bank accounts.

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