Limitations to the Scope and Binding Force of Advance Directives: The Conflict Between Compulsory Treatment and the Right to Self-Determination

  • Jacqueline M. Atkinson
  • Jacquie Reilly
Part of the International Library of Ethics, Law, and the New Medicine book series (LIME, volume 54)


Advance planning for people with mental illness involves allowing competent individuals to specify their treatment preferences in advance of future incapacity. Supporters of advance planning argue that it can enhance autonomy and allow people to participate in their future treatment decisions, allowing patients and clinicians to engage in a constructive approach to treatment planning, while opponents claim that advance directives are problematic both legally and ethically and not workable in practice. To argue that advance directives are useful in psychiatry means being clear about what they are intended to achieve and thus what outcome measures might be appropriate. Outcome measures may best be suggested by both the type of advance directive involved and the philosophy behind it. Autonomy and empowerment, for example, would be best assessed by asking patients whether having the plan had made them feel more involved or in control when detained or admitted. Where compulsory detention or treatment is needed, questions arise as to how to balance a patient’s right to autonomy and self-determination with a physician’s duty of care. There is undoubtedly an inherent conflict and a balance to be struck between the two. The main issues that arise relate to the capacity of an individual to make an advance directive, when a directive is written and what it actually contains.


Mental Illness Advance Directive Advance Statement Advance Planning Coercive Treatment 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Agnetti, G. 2008. The consumer movement and compulsory treatment: A professional outlook. International Journal of Mental Health 37(4): 33–45.CrossRefGoogle Scholar
  2. Atkinson, J.M. 2007. Advance directives in psychiatry: Theory, practice and ethics. London: Jessica Kingsley.Google Scholar
  3. Atkinson, J.M., and H.C. Garner. 2003. Advance directives in mental health. Psychiatric Bulletin 27: 437.CrossRefGoogle Scholar
  4. Atkinson, J.M., H.C. Garner, and W. Harper Gilmour. 2004. Models of advance directives in mental health care: Stakeholder views. Social Psychiatry and Psychiatric Epidemiology 39(8): 673–680.PubMedCrossRefGoogle Scholar
  5. Backlar, P., B.H. McFarland, J.W. Swanson, and J. Mahler. 2001. Consumer, provider, and informal caregiver opinions on psychiatric advance directives. Administration and Policy in Mental Health 28: 427–441.PubMedCrossRefGoogle Scholar
  6. Halpern, A., and G. Szmukler. 1997. Psychiatric advance directives: Reconciling autonomy and non-consensual treatment. The Psychiatrist 21: 323–327.Google Scholar
  7. La Fond, J., and D. Srebnik. 2002. The impact of mental health advance directives on patient perceptions of coercion in civil commitment and treatment decisions. International Journal of Law and Psychiatry 25(6): 537–555.PubMedCrossRefGoogle Scholar
  8. Morrissey, F. 2010. Advance directives in mental health care: Hearing the voice of the mentally ill. Medico Legal Journal of Ireland 16(1): 21.Google Scholar
  9. O’Reilly, R., J. Grey, and S. State. 2009. An exchange of views on what constitutes reasonable review of treatment capacity. Research Insights 6(2): 1–14.Google Scholar
  10. Papageorgiou, A., M. King, A. Janmohamed, O. Davidson, and J. Dawson. 2002. Advance directives for patients compulsorily admitted to hospital with serious mental illness: Randomised controlled trial. The British Journal of Psychiatry 181: 513–519.PubMedCrossRefGoogle Scholar
  11. Papageorgiou, A., A. Janmohamed, M. King, O. Davidson, and J. Dawson. 2004. Advance directives for patients compulsorily admitted to hospital with serious mental disorders: Directive content and feedback from patients and professionals. Journal of Mental Health 13: 379–388.CrossRefGoogle Scholar
  12. Reilly, J., and J. Atkinson. 2010. The content of mental health advance directives: Advance statements in Scotland. International Journal of Law and Psychiatry 33(2): 116–121.PubMedCrossRefGoogle Scholar
  13. Scottish Executive. 2004. The new mental health act: A guide to advance statements. Edinburgh: Scottish Executive.Google Scholar
  14. Scottish Parliament. 2003. Mental health (care and treatment) (Scotland) act. Edinburgh: Stationery Office.Google Scholar
  15. Sjöstrand, M., and G. Helgesson. 2008. Coercive treatment and autonomy in psychiatry. Bioethics 22(2): 113–120.PubMedCrossRefGoogle Scholar
  16. Srebnik, D., and L. Brodoff. 2003. Implementing psychiatric advance directives: Service provider issues and answers. The Journal of Behavioural Health Services & Research 30: 253–268.CrossRefGoogle Scholar
  17. Srebnik, D.S., J. Russo, J. Sage, T. Peto, and E. Zick. 2003. Interest in psychiatric advance statements among high users of crisis services and hospitalistion, paychiatric services 54: 330–336.Google Scholar
  18. Swanson, J.W., M.S. Swartz, E.B. Elbogen, R.A. Van Dorn, J. Ferron, H.R. Wagner, B.J. McCauley, and M. Kim. 2006. Facilitated psychiatric advance directives: A randomized trial of an intervention to foster advance treatment planning among persons with severe mental illness. The American Journal of Psychiatry 34: 43–57.Google Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2014

Authors and Affiliations

  1. 1.Public HealthUniversity of GlasgowGlasgowUK
  2. 2.Public HealthUniversity of Glasgow School of MedicineGlasgowUK

Personalised recommendations