Alternatives to the Compassion in Dying Advance Directive Template for Northern Ireland
If you have been looking at the Compassion in Dying advance directive template and wondering whether it works for Northern Ireland, the honest answer is: partially, but with significant gaps that can undermine the document's enforceability. The template is designed for a pan-UK audience and leans on the English and Welsh Mental Capacity Act 2005 framework. Northern Ireland operates under common law for healthcare decisions, with stricter precision requirements and no equivalent statutory backstop. Here are the NI-specific alternatives and what each one actually covers.
Where the Compassion in Dying Template Falls Short in NI
Compassion in Dying provides a well-designed, free advance directive template that works well in England and Wales. The problems surface specifically in Northern Ireland:
Legal framework mismatch. The template references the Mental Capacity Act 2005, which does not apply in NI. Northern Ireland has its own Mental Capacity Act (NI) 2016, but its welfare-related provisions remain unimplemented. Healthcare decisions for incapacitated adults in NI are governed by common law — a stricter standard that requires more specific language than what the MCA 2005 framework demands.
Language too broad for NI common law. The template uses umbrella categories like "life-sustaining treatment" as a single refusal. Under NI common law, clinicians can set aside an ADRT that does not name the specific treatments being refused and the specific clinical circumstances in which the refusal applies. A single blanket refusal is harder to enforce than individual, treatment-specific clauses.
No EPA guidance. The template covers only the ADRT. In Northern Ireland, the Enduring Power of Attorney — which covers financial and property decisions — is a separate but equally urgent document. The Compassion in Dying template does not mention EPA registration, the OCP, or the controllership risk, leaving users with half the picture.
No NI clinical system context. The template does not explain how the ADRT interacts with ReSPECT forms and DNACPR notices used across the five NI Health and Social Care Trusts. In practice, this hierarchy matters — a ReSPECT form recommending full resuscitation does not override a valid ADRT refusing CPR, but hospital staff may not know this unless the patient or their advocate can explain it.
Your Alternatives
1. NI Healthcare Autonomy Toolkit
A comprehensive guide built exclusively for Northern Ireland's legal and healthcare system.
What it covers:
- ADRT drafting with clinically precise, treatment-specific templates (CPR, ventilation, tube feeding, antibiotics, dialysis — each with clinical trigger conditions)
- EPA registration walkthrough under the Enduring Powers of Attorney (NI) Order 1987
- OCP controllership avoidance strategy with fee schedules
- ReSPECT and DNACPR coordination across the five HSC Trusts
- Signing and witnessing checklist for the life-sustaining treatment declaration
- GP consultation worksheet for capacity confirmation
- Bereavement administration chapters (probate, benefits, death registration)
- Eight standalone printable worksheets
Cost: $24
Best for: People who want a self-directed, complete process — ADRT plus EPA plus the clinical context to advocate effectively. Especially strong for caregivers helping an ageing parent and anyone who needs to act within the 30–90 day capacity window after a diagnosis.
2. NI Solicitor
A solicitor drafts the ADRT (and usually EPA) for you based on your instructions.
What it covers:
- Professionally drafted documents
- File note evidencing your capacity at the drafting session
- EPA registration managed on your behalf
- Legal advice on complex situations (cross-border, family disputes)
Cost: Fees vary by firm and complexity; EPA drafting and registration fees start at several hundred pounds, plus the £189 OCP registration fee.
Best for: Contested family situations, cross-border legal complications, or anyone who wants someone else to handle the entire process. Services and document scope vary by firm, so ask how the ADRT will address treatment-specific refusals and NI common-law requirements.
3. NI Direct / Department of Health NI Guidance
The official government information on advance care planning in Northern Ireland.
What it covers:
- Overview of what an advance decision is
- Basic information on EPA registration
- Links to the Office of Care and Protection
- General guidance on capacity and decision-making
Cost: Free.
Best for: Initial orientation — understanding what documents exist and which government agencies are involved. The limitation is significant: NI Direct provides information, not templates or drafting guidance. The content is written for a general audience and does not include the clinical precision required for an enforceable ADRT. It also fragments across multiple pages with no single integrated walkthrough.
4. Macmillan "Your Life and Your Choices"
A charity booklet providing general advance care planning guidance.
What it covers:
- Accessible explanation of advance decisions, advance statements, and power of attorney
- Emotional guidance on having conversations about end-of-life wishes
- Some NI-specific notes within a pan-UK framework
Cost: Free.
Best for: People who want to understand the concept before committing to action. A good conversation starter but not a drafting resource — it does not include templates, NI-specific fee schedules, or the OCP controllership timeline. The pan-UK framing means NI readers must mentally filter out the England-and-Wales-specific content.
5. Age NI
Age NI provides advice services and factsheets covering legal and financial planning for older adults in Northern Ireland.
What it covers:
- Factsheets on EPA, advance care planning, and care home funding
- Advice services and factsheets
Cost: Free.
Best for: Older adults or their families who want to speak to someone before taking action. Age NI's factsheets are NI-specific and reliable. The limitation is that they are information resources, not drafting tools — they explain what an ADRT is and why it matters but do not provide the templates or step-by-step process to create one.
Comparison at a Glance
| Factor | Compassion in Dying | NI Toolkit | Solicitor | NI Direct | Macmillan | Age NI |
|---|---|---|---|---|---|---|
| NI-specific legal framework | No (MCA 2005) | Yes (common law) | Yes | Partially | Partially | Yes |
| ADRT drafting templates | Generic | Treatment-specific | Drafted for you | None | None | None |
| EPA registration guidance | None | Full walkthrough | Usually bundled | Basic | Basic | Basic |
| ReSPECT/DNACPR hierarchy | None | Yes | Rarely | None | None | None |
| OCP controllership guidance | None | Yes, with fees | Yes | Basic | None | Basic |
| Bereavement administration | None | Full chapters | Not included | Separate pages | None | Separate factsheets |
| Cost | Free | $24 | Varies; EPA work starts at several hundred pounds | Free | Free | Free |
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Who This Comparison Is For
- Anyone in Northern Ireland who started with the Compassion in Dying template and realised it references English law
- Caregivers researching the best tool before helping a parent with advance care planning
- People who have seen multiple UK-wide resources and cannot tell which one actually applies in NI
- Self-planners who want an NI-specific solution without solicitor costs
Who Should Stay With a Solicitor
- Families with active disputes about a relative's healthcare wishes
- Anyone with cross-jurisdictional complications (NI plus Republic of Ireland or Great Britain assets and care arrangements)
- Situations where the Office of Care and Protection is already involved
The Advance Decision to Refuse Treatment guide was designed specifically as the NI-specific alternative to pan-UK templates — clinically precise drafting language, the EPA registration process, and the clinical document hierarchy in one resource.
Frequently Asked Questions
Is the Compassion in Dying template completely invalid in Northern Ireland?
It is not invalid, but it is weaker. An ADRT made using the Compassion in Dying template can still be legally binding under NI common law if it happens to be specific enough for the clinical situation that arises. The risk is that the template's broad language may give clinicians grounds to argue it does not apply to the precise treatment and circumstances; treatment-specific, NI-focused templates address that risk more directly.
Can I start with the Compassion in Dying template and adapt it for NI?
You can, but adapting a pan-UK template for NI requires replacing every generic treatment category with specific treatment names, adding clinical trigger conditions for each refusal, ensuring the life-sustaining treatment declaration meets NI common law execution requirements, and removing all references to the Mental Capacity Act 2005. At that point, you have effectively drafted a new document. Starting with an NI-specific resource saves the adaptation effort.
Can Age NI help with advance directive work?
Age NI provides information and factsheets on advance decisions, but these are information resources rather than ADRT drafting tools. For a complex situation, seek advice from a Northern Ireland solicitor.
What about Marie Curie's "My Wishes & Plans" checklists?
Marie Curie's "My Wishes & Plans" checklists are useful conversation guides for clinical settings but are not ADRT drafting tools — they record general wishes and preferences rather than creating a legally binding treatment refusal document. They complement an ADRT but do not replace one.
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