(October 20th 2025) New research carried out at TUH reveals a need for greater education among patients and staff about Advanced Healthcare Directives (AHDs or living wills). The findings coincide with the launch of a brand new guide on the topic for staff, the first of its kind in Ireland. The guide will help healthcare staff to think creatively to support patients making their own decisions and through AHD’s making their choices known.
An AHD is a legal document that is used when a person loses the ability to make or communicate decisions about their care. It informs family members, carers, and healthcare professionals of the person’s preferences for treatment if they are no longer able to express them. For example, someone may choose not to be resuscitated if their heart stops or may refuse life support such as a ventilator. AHDs ensure that a person's healthcare choices are respected, even when they are unable to voice them.
For this latest paper, researchers surveyed knowledge of and attitudes towards AHDs among 120 inpatients and 102 staff at TUH after it became clear they were rarely used due to a lack of understanding and awareness in care planning. The research began just one year after the new law on AHDs was first introduced in Ireland in April of 2023.
Consultant Psychiatrist at TUH & Trinity College Dublin, Professor Brendan Kelly said, “None of the patients we interviewed had created an Advanced Healthcare Directive, and only 11.7% were even aware of them. However, two-thirds said they would be willing to make one if supported by their healthcare provider. We additionally found that the vast majority of staff (84.3%) and patients (61.7%) would prefer an advance care plan that was not legally binding but included the patient’s will and preferences. We are not unique in Ireland; the need for greater knowledge about AHDs is common across many jurisdictions, among both healthcare providers and patients. Our new guide for staff is an important first step in raising awareness.”
Of the patients who took part in this study, 65 were on surgical wards and 55 were on medical wards. The item that most patients wanted to include in AHDs was requests for specific medications or other treatments.
Of the 102 healthcare staff who participated in the study, 35 worked in surgical wards and 67 in medical wards. These included non-consultant hospital doctors (residents), staff nurses, student nurses, physiotherapists, speech & language therapists, dietitians, occupational therapists, and pharmacists.
82 staff had heard of AHDs, and eight staff had assisted a patient in making one, while 46 had cared for a patient with one. The item that most staff wanted to see included in AHDs was whether a refusal of treatment is to be respected, even if it means no further treatment for the patient other than ensuring they are comfortable.
Senior Social Worker and the Decision-Making Act Lead at TUH, Holly Canavan, said, “There is certainly a need for greater education about AHDs, which is why our hospital has produced a new guide for staff in line with the nine guiding principles of this important new legislation, called the Assisted Decision-Making Act. This will, in turn, help patients as healthcare providers become aware of their legal and ethical obligation to support decision making by patients rather than substitute it and to uphold each patient's preferences if they later lose decision-making capacity.”
A full copy of the study can be accessed via this link.
ENDS
