After Etaoin’s stepfather was diagnosed with vascular dementia in April, his medical consultant suggested that the family organise an enduring power of attorney as soon as possible.“When we came out of dealing with the consultant, all Mam [had] heard was the stuff around dementia. But [my stepfather] was like: ‘Me and you need to go to a solicitor’,” says Etaoin, a teacher in Co Wicklow.However, her 80-year-old stepfather and 72-year-old mother had already made their wills, and the relatively new system of registering an enduring power of attorney does not have to involve a solicitor initially, although they still have a role in it (see below).“My mam wanted to do [hers] at the same time. She said, if we’re doing one, we might as well do two.” And so began Etaoin’s crash course in prudent planning for her parents’ future. Her stepfather still had the ability to make his own decisions in all of this but the consultant warned that they could be looking at a different man within six months.As with many other families, it took a crisis to initiate the process. Common sense would suggest these are conversations parents should be having with their adult children, and vice versa, well before any need arises. Yet it is human nature to procrastinate on such matters, not wanting to countenance the prospect of illness, incapacity and dying, for oneself or a loved one.Etaoin’s stepfather remarked to her: “Why didn’t we do this years ago?” He is not the first, and will not be the last, to think that in hindsight.“None of us know the day or the hour when we might have a difficulty exercising our own right to make decisions,” says Áine Flynn, director of the Decision Support Service (DSS), the role of which includes registering and supervising all enduring power-of-attorney arrangements. The service started operating three years ago under the Assisted Decision Making Capacity Act, which was signed into law at the end of 2015, but not commenced until April 26th, 2023. This abolished the wards-of-court system for people deemed incapable of making their own decisions. An enduring power of attorney, an advance healthcare directive and a will are three pillars of planning ahead. They are very different in nature but all are legally recognised ways for an individual to have their wishes known and honoured if and when they are no longer able to express them. “It’s kind of a holy trinity. That’s what we encourage people to think about,” says Flynn. About a third of people over 18 in the State have made a will. Research by the Decision Support Service indicates that only 8 per cent have created an enduring power of attorney and 7 per cent an advance healthcare directive.“At least 90 per cent of people think they’re a great idea, but then getting around to it is the thing,” says Flynn. A campaign to encourage advance planning, entitled You Know Me, has been launched by the Mental Health Commission, the Health Service Executive and the Department of Children, Disability and Equality. While the concept of wills needs no explanation, here’s a look at the other two, lesser-known processes:What is an enduring power of attorney (EPA)?An individual uses this to give to somebody they know and trust the authority to act on their behalf if they lose capacity to make certain decisions in the future. This can cover personal welfare, eg decisions about where they might live, as well as giving them a role in managing financial affairs, such as bank accounts, taxes, debts, property and other assets. Financial institutions are unlikely to share any information about accounts in a sole name with a “next of kin”, never mind enable access to funds, without an EPA – or some other, more costly, legal direction.The person making the EPA is known as the “donor”, while the family member, friend or whoever they are giving the authority to, is the “attorney” – not to be confused with the US term for a lawyer. The completed document, which cannot include decisions about future medical treatment (see below), has to be registered with the DSS.An EPA will not be activated until a second stage, which requires statements by two doctors or other specified health/social care practitioners that the donor no longer has the capacity to make their own decisions.“You may not need the EPA ever to come into effect,” says Flynn. “One hopes that doesn’t happen.” If it does need to be activated, the DSS supervises its use, requiring the attorney to file an annual report.What is an advance healthcare directive (AHD)?It is a legally recognised expression of an individual’s wishes for how medical treatment decisions might be made if, when the time comes, they are unable to give or refuse consent for themselves. For instance, if there are circumstances in which they would want to refuse life-sustaining treatment (not to be confused with assisted dying, which is not legal in Ireland), this is the place to put that on record. Or maybe there is already a specific diagnosis and the person has clear views on their preferred treatment path.The individual can also use this document to nominate a designated healthcare representative. That person then has the power to ensure that the wishes outlined in the AHD are complied with.“You can express what you want in terms of treatment, but requests are non-binding,” explains Flynn. “You could ask for something that just isn’t clinically indicated or available, or [is] experimental. But that has to still be countenanced and recorded, if the healthcare provider is not going to follow your request.”However, when it comes to refusal of treatment, what you’ve put in the AHD “is just the same as saying ‘no thank you, doctor’, in the present tense”.Where do I start?With research, whether you are looking ahead for yourself or for another. There is the excellent, wide-ranging Think Ahead planning pack available from the Irish Hospice Foundation (downloadable from hospicefoundation.ie or by post by calling 01 679 3188). In the advance planning arrangements section of the DSS website, decisionsupportservice.ie, there are extensive, easy-to-read guides to EPAs and AHDs.Then what?Begin a conversation with at least one trusted person in your life. Ideally this whole process is something to do “at a time of calm in your life with no sense of needing it soon”, says Flynn.Think about what you would want for yourself in the future, says Valerie Smith, public engagement lead with the Irish Hospice Foundation. If you’re asking someone else to act on your behalf, you need to be clear on what you are asking them to do.Valerie Smith, Irish Hospice Foundation “Start with quality of life. What matters to me the most? Let that settle,” she suggests, before looking at who needs to be in on the conversation. Then “practise this conversation with someone you trust, someone you know is not going to shut down the conversation”, before engaging with others. If you’re the listener and perhaps caught unawares when someone raises the topic, try not to dismiss them by responding, “Why would you be thinking about that?” Instead, she says, use questions such as, “What makes you think that this is something you need to do?” Or, “What are you most concerned about?” This will keep the conversation open, “even if you’re not quite ready to have it”. But there is no need to have a lengthy discussion covering all bases there and then. Instead, perhaps propose to come back to it the following week, allowing for time to reflect in between. Thoughts will evolve and be clarified over a series of conversations.“You can move through it slowly when you’re not in a crisis and that’s the point,” says Smith.How is an EPA prepared?When an individual knows what they want and has at least one person who has agreed to be their attorney, an online DSS account needs to be set up, through which forms are created and documents submitted. Members of the public can now do it for themselves and only require a solicitor or barrister to complete a statement that needs to be submitted as part of the application. [ Getting an enduring power of attorney in place is proving a tough taskOpens in new window ]However, individuals are advised to consider using a solicitor, particularly if there are complex issues. A statement of capacity is also required from a healthcare professional. There is a step-by-step guide to making and submitting an EPA application on the DSS website and there is no denying that it may appear to be a daunting task.“There’s a bit to it,” says Flynn. “We don’t minimise that – you’re not booking a train ticket.” But the service’s help desk is geared up to assist the public. After submission, the application is reviewed to make sure the EPA complies with all legal requirements before it is registered for a fee of €30.If there is huge urgency, let the DSS know, she advises. They have registered EPAs for people ranging in age from 27 to 107 and the quickest turnaround was within 48 hours for somebody who rang on a Monday to say they were undergoing brain surgery the following Wednesday.How is an AHD prepared?This is less onerous than drawing up an EPA. Again there is guidance on the DSS website, including a template to use, and also in the hospice foundation pack. An AHD is not registered but it is does need to be properly signed and witnessed to be valid. It is also important that at least one relevant person knows of its existence, such as a family member and/or GP. As in the case of an EPA, an AHD is only is pressed into service if you have verifiably lost capacity to give or withhold consent.What if I change my mind about what I’ve put in the documents?Once an EPA has been registered with the DSS for more than six months, it can be changed once a year. Any changes, known as “varying” the arrangement, must be made in writing, signed and witnessed – but this can all be done online.“What’s nice about Think Ahead is that it is easy to change,” says Smith. “Even if you’ve made your medical decisions, you can rewrite that next week if you have all the right people there to sign. “You can download it for free, so it’s easy to change and to update – actually, we would recommend updating it pretty regularly.”Etaoin initially approached several solicitors and then an advocacy organisation about helping her with the EPA. It was only when she got no satisfaction from those that she rang the DSS directly.“I expected to be given very little information and it to be all legal jargon,” she admits. “I didn’t expect them to be really easy going, and they made the process extremely simple.” She wants other families to know that they could just pick up the phone to the DSS because they “will literally handhold you” through it. “It’s for peace of mind, if anything were to happen Mam, or even health wise. I’ve had friends who haven’t had this in place and have been put to hell and back with their parents.“I actually think,” she adds, “because I’m single, I need to do this for myself.”The Decision Support Service help desk is 01 211 9750 or queries@decisionsupportservice.ie. The Irish Hospice Foundation support line, 1800 607066. operates Monday-Friday, 9am-6pm.