An advance healthcare directive (AHD) records the medical treatments you would refuse, or would like, if you later lose capacity to decide. In Ireland it is recognised under the Assisted Decision-Making (Capacity) Act 2015. A clear refusal of treatment is legally binding when it is valid and applies to the situation. A request for treatment is not binding, but your doctors must consider it. You can name a designated healthcare representative to make sure it is followed. An AHD is free to make. You sign it in front of two witnesses. There is no register, and you do not send it to the Decision Support Service (DSS). Instead, you give copies to your GP and the people who need them. There are limits. You cannot refuse basic care. Some refusals of mental health treatment can be overridden if you are an involuntary patient.
This guide covers what an AHD can and cannot do, the mental health exception, and how to make one. Information checked 2 November 2026.
Any adult aged 18 or over who has capacity at the time can make an AHD. You do not need a formal capacity assessment. But if you lacked capacity when you made it, a healthcare professional may treat it as invalid. You do not need a solicitor.
You can make one at any stage of adult life. The DSS says AHDs may be especially useful if you have:
That last group includes many brain conditions. If you have just been diagnosed with mild cognitive impairment, a young-onset dementia or Parkinson's disease, now is a good time to consider one.
You can refuse a specific medication, treatment, surgery or therapy. For a refusal to bind your doctors, three conditions must be met:
Being specific is the whole point. The DSS guidance says doctors can only be bound by your wishes if they know exactly what they are.
You can refuse life-sustaining treatment. To do so, the AHD must say clearly that the refusal applies even if your life is at risk. The DSS lists examples such as mechanical ventilation, artificial nutrition and hydration, CPR, dialysis and chemotherapy.
You can ask for treatments, for example one you know works for your condition. A request is not legally binding. You cannot insist on something unavailable or clinically inappropriate. But if a doctor does not follow a relevant request, they must record why in your records. They must give a copy to your designated healthcare representative within 7 working days.
The Medical Council's 2024 ethics guide tells doctors the same: an AHD must be respected if it clearly sets out the decisions and circumstances. Doctors should also take reasonable steps to find out whether a patient who lacks capacity has one.
The Act and the DSS set clear limits.
If it is unclear whether your AHD applies, the doctor must consult your representative, or your family and friends. They must also get a second professional's opinion. If it is still unclear, they must resolve it in favour of preserving your life.
This section matters most if you live with a mental health condition. The rules are in section 85(7) of the 2015 Act, as amended in 2023.
An AHD must normally be followed. The exception is when your treatment is regulated by Part 4 of the Mental Health Act 2001. In practice, that means you are an involuntary patient in an approved centre.
The 2001 Act has two grounds for involuntary admission:
The same exception applies to anyone on a conditional discharge order under the Criminal Law (Insanity) Act 2006.
One protection always holds. A refusal of treatment for a physical illness unrelated to your mental disorder must be complied with, even if you are detained.
So an AHD cannot guarantee you will avoid all mental health treatment in a crisis. But it still matters. Your stated wishes and requests remain on record. The DSS also notes you can make a separate AHD just for mental health decisions, with a different representative.
If you take an antipsychotic, our guide to what antipsychotics actually do may help you decide what to record.
The Mental Health Act 2026 was signed into law on 7 May 2026. It includes a revised approach to consent to treatment. The Department of Health said work had begun to commence it. The revised 2015 Act, up to date to 13 October 2026, still refers to the 2001 Act. Until the new Act is commenced, the rules above apply. Check with Citizens Information before relying on them.
You do not have to appoint one. Your AHD still works without a representative. But a representative can make sure it is found and followed. If you give them the power, they can also interpret your wishes and consent to or refuse treatment based on your AHD.
They only act if you lose capacity for the decisions in question. They must act in line with your will and preferences as set out in the AHD. You can name one representative and one alternate per AHD.
Your representative must be 18 or over. These people cannot act:
The last two exclusions do not apply to your spouse, civil partner, cohabitant, parent, child or sibling.
Once the AHD is in use, your representative must record each relevant decision within 7 working days. If you regain capacity, you can ask to see that record. The DSS can also ask for it.
Anyone can complain in writing to the DSS about how a representative uses their powers. The DSS can send a visitor to look into it.
If you cannot sign, another adult who is not a witness can sign for you, in your presence and at your direction. You can record your wishes by audio or video. But you must produce a written version to sign and have witnessed. If you write it in a language other than English or Irish, get it translated.
You do not have to tell anyone, and there is nothing to register. The law does require that your representative and alternate have a copy. The DSS strongly recommends giving copies to:
Keep paper and digital copies. Do not store it somewhere no one can reach.
You can change your AHD at any time while you have capacity. A change must be in writing, signed by you and two witnesses, and by your representative. You can cancel it at any time, in writing. Tell everyone who has a copy.
The DSS suggests reviewing it regularly, annually if possible. Review it after any major diagnosis or treatment, or if a new treatment becomes available.
They do different jobs. An enduring power of attorney covers personal welfare and property and affairs. It cannot cover healthcare treatment decisions. Only an AHD can. The DSS recommends considering both if you are planning ahead.
Without an AHD, your family cannot make treatment decisions for you. The DSS says next of kin have no authority to put a Do Not Attempt Resuscitation order in place for you.
First, make sure the treating team has a copy. Ask why it is not being followed. Doctors will only follow it if it is valid and applies to the treatment being considered. If you are not satisfied, ask for the service's review or complaints procedure. If that fails, an application can be made to the Circuit Court. Disputes about life-sustaining treatment go to the High Court. Get legal advice before going to court.
If you or someone you know is about to harm themselves or someone else, phone 112 or 999, or go to an emergency department. You can call Samaritans free on 116 123, or Pieta on 1800 247 247, at any time. You can also text 50808.
No. There is no register of AHDs, and you do not send it to the DSS. Give copies to your GP, your representative and anyone likely to be involved in your care.
Refusals of treatment are binding when the AHD is valid and applies to the situation. Requests are not binding, but must be considered, and a doctor who does not follow one must record why.
You can write the refusal, and it is generally binding. But if you are detained as an involuntary patient on the "serious harm" ground, it can be overridden. Refusals about unrelated physical illness must still be followed.
No. It is free to make, change or cancel. You do not need a solicitor.
No. Family members cannot make treatment decisions for you just because they are next of kin. Your doctors must still consider your known wishes.
This article is general information about Irish law, not legal or medical advice. Talk to your GP about treatment choices, and a solicitor or Citizens Information about your situation.
Reviewed by: Proco Team
Last updated: November 2026