Ulysses contract in psychiatry

Abstract

Over the last twenty years we have witnessed a growing focus on the rights of the ill people. The debate on informed consent and a new redefinition of the therapeutic relationship is constantly evolving. With this article, we propose a critical literature review of the so-called "Ulysses contract" or "psychiatric advance directives". It refers to the will that a subject expresses in writing, or orally, about the treatments he or she wishes or does not wish to be subject to if the time comes when it may be impossible to express his/her consent. This can especially occur in those with psychiatric disorders with serious clinical involvement and remitting-relapse (typically bipolar disorder, but also chronic delusional disorders and schizophrenia). In this context, the question is whether during intercritical periods the patient may or may not leave instructions to their care-givers. This aspect opens up to a series of interdisciplinary problems. In this article, we want to show the complexity of this debate from a clinical, ethical, legal and psychodynamic point of view, emphasizing the strengths and the major criticisms of the psychiatric advance directives for each area.