Abstract

This paper examines the potential for advance directives to be used by people with mental illness. Also known as a ‘living will’, an advance directive enables a competent person to make decisions about future treatment, anticipating a time when they may become incompetent to make such decisions. In Englishlaw, if “clearly established” and “applicable to the circumstances”, an advance directive assumesthe same statusas contemporaneous decisions made by a competent adult. A psychiatric advance directive, anticipating relapse of a psychosis, develops the concept of the living will. We argue it could reconcile two apparently contradictory themes in the current practice of psychiatry - on the one hand, the call to provide for non-consensual treatment outside hospital, and on the other, the promotion of patient autonomy.

Highlights

  • This paper examines the potential for advance directives to be used by people with mental illness

  • Known as 'living wills', provide an opportunity to carry into an antici pated period of compromised autonomy in the future, decisions made while authors are auton omous

  • Under English law the unambiguous and informed advance re/usals of competent adults are as valid and legally binding as their con temporaneous decisions, but advance consents are not legally enforceable as no one can require that medical treatment be given

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Summary

Adina Holpern and George Szmukler

This paper examines the potential for advance directives to be used by people with mental illness. Known as 'living wills', provide an opportunity to carry into an antici pated period of compromised autonomy in the future, decisions made while authors are auton omous. Our view is that the concept of an advance directive should apply to other situations where capacity is predictably lost, including those which may be reversible This is the case in some psychotic disorders, it must be recog nised that having a mental illness does not mean a patient is necessarily incompetent to make treatment decisions (Appelbaum & Grisso, 1995). While drafted with non-psychiatric patients in mind, they could be applied to patients with mental dis orders (Appelbaum, 1991)

Advantages oJPADs
Evaluating competence
Resource implications
Relationship to compulsory detention
Conclusions
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