Hostname: page-component-745bb68f8f-s22k5 Total loading time: 0 Render date: 2025-02-09T22:58:17.875Z Has data issue: false hasContentIssue false
  • English
  • Français

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
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

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

References

Appelbaum, P. S. (1991) Advance directives for psychiatric treatment. Hospital and Community Psychiatry, 42, 983–984.Google Scholar
Appelbaum, P. S. & Grisso, T. (1995) The MacArthur Treatment Competence Study: I. Mental illness and competence to consent to treatment. Law and Human Behaviour, 19, 105–126.Google Scholar
Department of Health and the Welsh Office (1993) Mental Health Act Code of Practice (2nd edn). London: HMSO.Google Scholar
Dresser, R. (1984) Bound to treatment: the Ulysses Contract. Hastings Center Report, 14, 13–16.Google Scholar
House of Commons Select Committee (1993) Health Committee Fifth Report, Community Supervision Orders. London: HMSO.Google Scholar
Law Commission (1995) Mental Incapacity, No. 231. London: HMSO.Google Scholar
Perling, L. J. (1993) Health care advance directives: implications for Florida mental health patients. University of Miami Law Review, 48, 193–228.Google Scholar
Rogers, J. A. & Centifanti, J. B. (1991) Beyond ‘self-paternalism’: a response to Rosenson and Hasten. Schizophrenia Bulletin, 17, 9–14.Google Scholar
Rosensen, M. K. & Kasten, A. M. (1991) Another view of autonomy: arranging for consent in advance. Schizophrenia Bulletin, 17, 1–7.Google Scholar
Royal College of Psychiatrists (1993) Community Supervision Orders: Discussion Document London: Royal College of Psychiatrists.Google Scholar
Szasz, T. S. (1982) The psychiatric will: a new mechanism for protecting persons against “psychosis” and psychiatry. American Psychologist, 37, 762–770.Google Scholar

Law reports

B v Croydon Health Authority (1995) 1 All ER683.Google Scholar
Re C (Adult: Refusal of Treatment) [1994] 1 WLR290.Google Scholar
Re KB (1994) Unreported case of 28th January 1994 before Mr Justice Ewbank.Google Scholar
Re T (Adult: refusal of medical treatment) (1993) FAM 95.Google Scholar
Re W (A Minor) (Consent to Medical Treatment) (1992) 3 WLR758, 769.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.