Do not attempt cardiopulmonary resuscitation decision-making process: scoping review.

OBJECTIVES: To conduct a scoping review to explore the evidence of the process of do not attempt cardiopulmonary resuscitation (DNACPR) decision-making. METHODS: We conducted a systematic search and review of articles from 1 January 2013 to 6 April 2023 within eight databases. Through multi-disciplinary discussions and content analytical techniques, data were mapped onto a conceptual framework to report the data. RESULTS: Search results (n=66 207) were screened by paired reviewers and 58 papers were included in the review. Data were mapped onto concepts/conceptual framework to identify timing of decision-making, evidence of involvement, evidence of discussion, evidence of decision documented, communication and adherence to decision and recommendations from the literature. CONCLUSION: The findings provide insights into the barriers and facilitators to DNACPR decision-making, processes and implementation. Barriers arising in DNACPR decision-making related to timing, patient/family input, poor communication, conflicts and ethical uncertainty. Facilitators included ongoing conversation, time to discuss, documentation, flexibility in recording, good communication and a DNACPR policy. Challenges will persist unless substantial changes are made to support and promote examples of good practice. Overall, the review underlined the complexity of DNACPR decision-making and how it is a process shaped by multiple factors including law and policy, resource investment, healthcare professionals, those close to the patient and of central importance, the patient.

Decision making capacity assessment in general practice in Ireland.

INTRODUCTION: It has been reported internationally that doctors have a limited understanding of the legal standard that applies to decision making capacity (DMC). No research on this has been conducted in Ireland to date. We sought to assess the understanding of legal principles relating to capacity and consent among Irish general practitioners (GPs), alongside how DMC assessments are conducted. METHODS: This study utilised a cross-sectional cohort model circulating online questionnaires to Irish GPs associated with a university research network. Data were analysed using SPSS to conduct a variety of statistical tests. RESULTS: There were 64 participants, with 50% aged 35-44 years and 60.9% being female. Of these, 62.5% found DMC assessments time-consuming. Only 10.9% of participants felt extremely confident in their abilities; most participants (59.4%) felt 'somewhat confident' in their ability to assess DMC. Also, 90.6% of GPs routinely engaged with families when assessing capacity. GPs felt their medical training did not prepare them for DMC assessment (undergraduate 90.6%, non-consultant hospital doctor 78.1%, GP training 65.6%). 70.3% felt guidelines relating to DMC would be helpful and 65.6% felt they needed additional training. DISCUSSION AND CONCLUSIONS: Most GPs recognise the importance of DMC assessment, and it is not considered a complex or burdensome task. There was limited knowledge of the legal instruments relevant to DMC. GPs felt there should be extra support available to assist them with DMC assessment; specific guidelines for different categories of patients was found to be the most popular resource requested.

The AssistedDecisionm-Making (Capacity) Act 2015: Interrogating the guiding principles for a person with dementia.

Healthcare decision-making can present challenges for the person with dementia as many of the skills needed to navigate the decision-making process may be diminished or lost as a result of dementia. Currently in Ireland the law responds to this difficult dilemma by providing for a system of adult guardianship - and outside of that, a great deal of uncertainty. This is set to change when the Assisted Decision-Making Capacity Act (ADMCA) 2015 comes into force in the summer of 2022. The ADMCA aims to provide a modern statutory framework that supports decision-making by adults and enables them to retain the greatest amount of autonomy possible in situations where they lack or may shortly lack legal capacity. The Act aims to do this both through creating a set of guiding principles for decision-making and by the creation of formal decision-making agreements. This article aims to examine the guiding principles of the Act as they affect the person with dementia, and to assess the degree to which they will support and guide people with dementia and their healthcare professionals in making decisions. The guiding principles are of singular importance because they will govern any treatment decision by or for a person which is not the subject of a formal agreement. In interrogating the guiding principles of the Act the article seeks to identify ways in which the ADMCA differs from the equivalent legislation in England and Wales, the Mental Capacity Act (MCA) 2005. The MCA came into force in 2007 and therefore the discussion is informed by almost fifteen years operation of the MCA. The article will argue that not only is the ADMCA a huge step forward from the current position in Ireland but that a number of key differences between the MCA and the ADMCA mean that the ADMCA has the potential to be more empowering for the person with dementia.

The Vexed Question of the Voluntary Patient.

The current statutory framework in Ireland provides certain key safeguards for people who are admitted involuntarily for mental health treatment and care; the same legislation makes scant reference to the person who seeks treatment and care on a voluntary basis. This has led to concerns in relation to deprivation of liberty and to non-consensual medical treatment for these patients. This article seeks to examine the development of the law in relation to voluntary patients in Ireland and to assess in light of recent developments where Ireland now stands in terms of protecting the right of the voluntary patient to liberty.