Implementing psychiatric advance directives: Service provider issues and answers

Regular Articles

Abstract

Psychiatric advance directives (PADs) are an emerging method for adults with serious and persistent mental illness to document treatment preferences in advance of periods of incapacity. This article presents and responds to issues most frequently raised by service providers when planning for implementation of PADs. Issues discussed include access to PADs; competency to execute PADs; the relationship of PADs to standards of care, resource availability, and involuntary treatment; roles of service providers and others in execution of PADs; timeliness and redundancy of PAD information; consumer expectations of PADs; complexity of PADs; revocation and “activation”; legal enforceability of PADs; the role and powers of agents; liability for honoring and not honoring PADs; and use of PADs to consent for release of health care information. Recommendations are made for training staff and consumers, consideration of statute development, and methods to reduce logistical, attitudinal, and system barriers to effective use of PADs.

References

  1. 1.
    Srebnik D, LaFond J. Advance directives for mental health services: current perspectives and future directions.Psychiatric Services. 1999;50:919–925.Google Scholar
  2. 2.
    Szasz T. The psychiatric will: a new mechanism for protecting persons against “psychosis” and psychiatry.American Psychologist. 1982;37:762–770.Google Scholar
  3. 3.
    Appelbaum P. Advance directives for psychiatric care.Hospital and Community Psychiatry. 1991;42: 983–984.Google Scholar
  4. 4.
    Gallagher E. Advance directives for psychiatric care: a theoretical and practical overview for legal professionals.Psychology, Public Policy and Law. 1998;4:746–787.Google Scholar
  5. 5.
    Mester R, Toren P, Gonen N, et al. Anticipatory consent for psychiatric treatment: a potential solution for an ethical problem.Journal of Forensic Psychiatry. 1994;5:160–167.Google Scholar
  6. 6.
    Rogers J, Centifanti J. Beyond “self-paternalism”: response to Rosenson and Kasten.Schizophrenia Bulletin. 1991;17:9–14.Google Scholar
  7. 7.
    Sherman P. Advance directives for involuntary psychiatric care. In:Proceedings of the 1994 National Symposium on Involuntary Interventions: The Call for a National Legal and Medical Response. Houston: University of Texas; 1995.Google Scholar
  8. 8.
    Hoge S. The Patient Self-Determination Act and psychiatric care.Bulletin of the American Academy of Psychiatry & the Law. 1994;22:577–586.Google Scholar
  9. 9.
    Alaska Stat §47.30.950; Ariz Rev Stat §36-3221-3281; Hawaii Rev Stat Ann §327F; Idaho Code §§66-601-613; 755 Ill Comp Stat 43/1; La Stat Ann §28-221-235, Md Code Ann §5-601-617; Minn Stat Ann §253B.03(6)(d); Mont Code Ann §53-21-115-714; NC Gen Stat §122C-71-77; Okla Stat Ann 43A, §11-101-113; Ore Rev Stat §127.700-737 (1999); Tex Civ Prac & Rem Code Ann §§137.001-011; Utah Code Ann §§62A-12-501-504; Laws of Washington, Chapt 283 (2003); Wis Stat §155.20, Wyo Stat §35-22-302-308.Google Scholar
  10. 10.
    Fleischner R. Advance directives for mental health care: an analysis of State Statutes.Psychology, Public Policy and Law. 1998;4:788–804.Google Scholar
  11. 11.
    Backlar P, McFarland B, Swanson J, et al. Consumer, provider, and informal caregiver opinions on psychiatric advance directives.Administration and Policy in Mental Health. 2001;28:427–441.Google Scholar
  12. 12.
    Geller J. The use of advance directives by persons with serious mental illness for psychiatric treatment.Psychiatric Quarterly. 2000;71:1–13.Google Scholar
  13. 13.
    Anthony W.The Philosophy and Practice of Psychiatric Rehabilitation. Boston University: Center for Psychiatric Rehabilitation; 1991.Google Scholar
  14. 14.
    Miller R. Advance directives for psychiatric treatment: a view from the trenches.Psychology, Public Policy, and Law. 1998;4:728–745.Google Scholar
  15. 15.
    Srebnik D, Livingston J, Gordon L, et al. Housing choice and community success for individuals with serious and persistent mental illness.Community Mental Health Journal. 1995;31:139–152.Google Scholar
  16. 16.
    Swanson J, Tepper M, Backlar P, et al. Psychiatric advance directives: an alternative to coercive treatment?Psychiatry. 2000;63, 160–172.Google Scholar
  17. 17.
    Winick B. Advance directive instruments for those with mental illness.University of Miami Law Review. 1996;51:57–95.Google Scholar
  18. 18.
    Backlar P, McFarland B. A survey on use of advance directives for mental health treatment in Oregon.Psychiatric Services. 1996;47:1387–1389.Google Scholar
  19. 19.
    Rosenson M, Kasten A. Another view of autonomy: arranging for consent in advance.Schizophrenia Bulletin. 1991;17:1–7.Google Scholar
  20. 20.
    Winick B. Planning for the future through advance directive instruments.Psychology, Public Policy and Law. 1998;4:579–609.Google Scholar
  21. 21.
    Danis M, Southerland L, Garrett J, et al. A prospective study of advance directives for life-sustaining care.New England Journal of Medicine. 1991;324:882–888.Google Scholar
  22. 22.
    Fisher D. Making advance directives work for you.Natl Empowerment Cent Newsletter. 2000. Available at: www.power2u.org/selfhep/directive_work.html.Google Scholar
  23. 23.
    Sutherby K, Szmukler G, Halpern A, et al. A study of “crisis cards” in a community psychiatric service.Acta Psychiatrica Scandinavica. 1999;100:56–61.Google Scholar
  24. 24.
    Hawaii Rev Stat §327F-6.Google Scholar
  25. 25.
    United States General Accounting Office.Patient Self-Determination Act: Providers Offer Information on Advance Directives, But Effectiveness Uncertain. Report to the Ranking Minority Member, Subcommittee on Health, Committee on Ways and Means, House of Representatives; 1995.Google Scholar
  26. 26.
    Stavis P. The Nexum: a modest proposal for self-guardianship by contract. A system of advance directives and surrogate committees-at-large for the intermittently mentally ill.Contemporary Health Law & Policy. 1999;16:1–95.Google Scholar
  27. 27.
    Howe E. Lessons from advance directives for PADs.Psychiatry. 2000;63:173–177.Google Scholar
  28. 28.
    Kapp M. Implications of the Patient Self-Determination Act for psychiatric practice.Hospital and Community Psychiatry. 1994;45:355–358.Google Scholar
  29. 29.
    Dunlap J. Psychiatric advance directives: having one's say?Kentucky Law Journal. 2001;89: 327.Google Scholar
  30. 30.
    Tex Health & Safety Code Ann §576.002, Vernon, 1992;T.J.V. v State, 899 SW2d 379 (1995);Vo v Pham, 81 Wash App 781, 916 P2d 462 (1996),Binder v Binder, 50 Wash 2d 142, 309 P2d 1050 (1957).Google Scholar
  31. 31.
    Ritchie J, Sklar R, Steiner W. Advance directives in psychiatry.International Journal of Law and Psychiatry. 1998;21:245–260.Google Scholar
  32. 32.
    Molloy D, Silberfeld M, Darzins P, et al. Measuring capacity to complete an advance directive.Journal of the American Geriatric Society. 1996;44:660–664.Google Scholar
  33. 33.
    Sherman P. Computer-assisted creation of psychiatric advance directives.Community Mental Health Journal. 1998;34:351–362.Google Scholar
  34. 34.
    Appelbaum P, Grisso T. Assessing patients' capacities to consent to treatment.New England Journal of Medicine. 1988;319:1635–1638.Google Scholar
  35. 35.
    Grisso T, Appelbaum P.Assessing Competence to Consent to Treatment. New York: Oxford University Press; 1998.Google Scholar
  36. 36.
    Idaho Code §66-604(1).Google Scholar
  37. 37.
    Backlar P. The longing for order: oregon's medical advance directive for mental health treatment.Community Mental Health Journal. 1995;31:103–108.Google Scholar
  38. 38.
    Hawaii Rev Stat §327F-3(b)(4)(C), Wash Rev Code §70.122.030.Google Scholar
  39. 39.
    Dawson J, King M, Papageorgiou A, et al. Legal pitfalls of psychiatric research.British Journal of Psychiatry. 2001;176:67–70.Google Scholar
  40. 40.
    Halpern A, Szmukler G. Psychiatric advance directives: reconciling autonomy and non-consensual treatment.Psychiatric Bulletin. 1997;21:323–327.Google Scholar
  41. 41.
    Macklin A. Bound to freedom: the Ulysses contract and the psychiatric will.University of Toronto Faculty of Law Review. 1987;45:37–68.Google Scholar
  42. 42.
    La Stat Ann §28:224.Google Scholar
  43. 43.
    NC Gen Stat §122C-71, NC Gen Stat §122C-112, NC Gen Stat 32A §3. See also, La Stat Ann §28:229 and Alaska Stat §47.30.956.Google Scholar
  44. 44.
    Hargrave v Vermont, US Dist Ct for Vermont, File no. 2:99-CV-128, opinion and order dated October 11, 2001.Google Scholar
  45. 45.
    Emanuel E, Emanuel L. Four models of the physician-patient relationship.Journal of the American Medical Association. 1992;267:2221–2226.Google Scholar
  46. 46.
    Charles C, Gafni A, Whelan T. Decision-making in the physician-patient encounter: revisiting the shared treatment decision-making model.Social Science and Medicine. 1999;49:651–661.Google Scholar
  47. 47.
    Hare J, Nelson C. Will outpatients complete living wills? A comparison of two interventions.Journal of General Internal Medicine. 1991;6:41–46.Google Scholar
  48. 48.
    High D. Advance directives and the elderly: a study of intervention strategies to increase use.The Gerontologist. 1993;33:342–349.Google Scholar
  49. 49.
    Sachs G, Stocking C, Miles S. Empowerment of the older patient? A randomized, controlled trial to increase discussion and use of advance directives.Journal of the American Geriatrics Society. 1992;40:269–273.Google Scholar
  50. 50.
    755 Ill Comp Stat Ann §43/10, Or Rev Stat §127.702, La Stat Ann §28:222(B).Google Scholar
  51. 51.
    Alaska Stat §47.30.970, 755 Ill Comp Stat §43/75, Or Rev Stat §127.736.Google Scholar
  52. 52.
    Alaska Stat §47.30.956 and La Stat Ann §28:229.Google Scholar
  53. 53.
    Alaska Stat §47.30.950, Alaska Stat §47.30.980, Idaho Code §66-601, Idaho Code §66-613, 755 Ill Comp Stat §43/1, 755 Ill Comp Stat §43/1151, Okla Stat 43A §11-101, Okla Stat 43A §11-113, Or Rev Stat §127.700, Or Rev Stat §127.736.Google Scholar
  54. 54.
    Cuca R. Ulysses in Minnesota: first steps toward a self-binding psychiatric advance directive statute.Cornell Law Review. 1993;78:1152.Google Scholar
  55. 55.
    Dresser R. Bound to treatment: the Ulysses contract.The Hastings Center Report. 1984;6:13–16.Google Scholar
  56. 56.
    Hawaii Rev Stat §327F-1, Hawaii Rev Stat §327F-16, Alaska Stat §47.30.950, Alaska Stat §47.30.980Google Scholar
  57. 57.
    Sales G. The health care proxy for mental illness: can it work and should we want it?Bulletin of the American Academy of Psychiatry & the Law. 1993;21:161–179.Google Scholar
  58. 58.
    Wash Rev Code §11.94.043, Wash Rev Code §70.122.010.Google Scholar
  59. 59.
    In re Quinlan, 70 NJ 10, 355 A2d 647 (NJ 1976), andCruzan v Dir., Mo. Department of Health, 497 US 261, 110 S Ct 2841 (1990).Google Scholar
  60. 60.
    64(127)Federal Register, Rules and Regulations, 36069–36089 (July 2, 1999). From theFederal Register Online via GPO Access (wais.access.gpo.gov) 64Federal Register 36069, 36069–36089 (July 2, 1999).Google Scholar
  61. 61.
    Alaska Stat §47.30.962, Idaho Code §66.609, Or Rev Stat §127.720Google Scholar
  62. 62.
    Alaska Stat §47.30.962(2), Idaho Code §66.609(2), La Stat Ann §28:230, Or Rev Stat §127.720(1)(b).Google Scholar
  63. 63.
    In re Grant, 747 P2d 445 (Wash 1987), In re Colyer, 660 P2d 738 (Wash 1983), In re Ingram, 689 P2d 1363 (Wash 1984).Google Scholar
  64. 64.
    755 Ill Comp Stat Ann §43/10-43/75, Or Rev Stat §127.700.Google Scholar
  65. 65.
    Or Rev Stat §127.710.Google Scholar
  66. 66.
    Colo Rev Stat §15-14-506(3).Google Scholar
  67. 67.
    Brock D. A proposal for the use of advance directives in the treatment of incompetent mentally ill persons.Bioethics. 1993;7:247–256.Google Scholar

Copyright information

© National Council for Community Behavioral Healthcare 2003

Authors and Affiliations

  1. 1.Department of Psychiatry and Behavioral SciencesUniversity of WashingtonSeattle
  2. 2.Seattle UniversityWashington

Personalised recommendations