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Psychiatric advance directives: reconciling autonomy and non-consensual treatment

Published online by Cambridge University Press:  02 January 2018

Adina Halpern  and
George Szmukler
Adina Halpern
Affiliation:
Trinity Hall, Cambridge CB2 1TJ
George Szmukler*
Affiliation:
Bethlem and Maudsley NHS Trust, Maudsley Hospital, Denmark Hill, London SE5 8AZ
*
∗Correspondence
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Abstract

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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.

Type
Editorials
Information
Psychiatric Bulletin , Volume 21 , Issue 6 , June 1997 , pp. 323 - 327
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
Copyright © 1997 The Royal College of Psychiatrists

References

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