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What’s a psychiatric advance directive?

Written by Diane Archer

We all need advance directives—living wills and health care proxies that enable us to identify a trusted friend or family member who can help ensure that our care wishes are honored if we cannot speak for ourselves. As more people come to recognize the value of advance directives, experts are seeking to expand upon them. Some have begun to promote dementia directives, and now others are promoting psychiatric advance directives.

The idea behind a psychiatric advance directive (PAD or mental health advance directive) is to best ensure that the wishes of someone living with a mental illness are honored if they are suffering from a mental disorder that prevents them from making medical decisions for themselves. Jennifer Adaeze Okwerekwu writes in StatNews that her patient with catatonia could “barely move or speak.” He did not want food or water, let alone medical treatment.

Because Dr. Okwerekwu’s patient did not have a psychiatric advance directive–a legal document outlining the patient’s treatment preferences should he not be able to state them–the doctor could not insist he receive treatment until he was in physical danger. His mental crisis without any physical crisis prevented any medical intervention. Had the patient had a psychiatric directive, he could have set forth in advance the medications he would have wanted, along with other information to ensure his care wishes were met.

Today, only some states allow patients to write psychiatric advance directives. New York is among them. In Virginia, psychiatric advance directives are only honored if signed by two witnesses, excluding the health care proxy. Massachusetts does not allow psychiatric advance directives but does allow a health care proxy the authority to direct the care of a patient when he or she is incapacitated. The Massachusetts law burdens psychiatric patients with having to speak with their proxies about their care wishes, when they are incapacitated, which can be challenging. To learn more about the law in your state, click here.

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