The capacity to execute an advance directive for psychiatric treatment

International Journal of Law and Psychiatry
Richard L O'Reilly

Abstract

When advance directives are used to reject standard psychiatric treatment they have the potential to place civilly committed patients in a catch-22 where they need psychotropic medication to ameliorate their symptoms in order to regain liberty but are bound by their previously expressed wish that medication be withheld. The capacity to make an advance directive is higher than that required to make a contemporaneous treatment decision. Furthermore, unlike the assessment of contemporaneous capacity, it is very difficult to determine a person's capacity retrospectively or to determine if an advance directive was meant to apply in changed circumstances. The author argues that when an advance directive demands a course of action that is contrary to a person's best interests the onus should fall on the person rejecting the care to demonstrate that he or she was capable when executing the directive and that the directive is meant to apply in the current circumstances.

References

Mar 28, 1991·The New England Journal of Medicine·L L EmanuelE J Emanuel
Jan 1, 1991·Schizophrenia Bulletin·M K Rosenson, A M Kasten
May 1, 1986·The Journal of Medicine and Philosophy·B Gert, K D Clouser
Dec 1, 1986·Hospital & Community Psychiatry·H I Schwartz, K Blank
Dec 1, 1981·Social Science & Medicine. Part F, Medical & Social Ethics·J M Humber
Oct 1, 1993·Journal of the American Geriatrics Society·M SilberfeldP A Singer
Jul 14, 1999·Psychiatric Services : a Journal of the American Psychiatric Association·D S Srebnik, J Q La Fond

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Citations

May 29, 2010·Cambridge Quarterly of Healthcare Ethics : CQ : the International Journal of Healthcare Ethics Committees·Alister Browne
Apr 3, 2010·Santé mentale au Québec·Daniel L Ambrosini, Anne G Crocker

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