Advance Directives For Mental Health Treatment: Clinical & Ethical Issues. Marvin Swartz, M.D. Department of Psychiatry & Behavioral Sciences Duke University Medical Center. What is an Advance Directive?.
Marvin Swartz, M.D.
Department of Psychiatry & Behavioral Sciences
Duke University Medical Center
“…in the opinion of a physician or eligible psychologist the person currently lacks sufficient understanding or capacity to make and communicate mental health treatment decisions.” G.S. 122C-72
New G.S. 122C-55(e2) “A responsible professional may disclose an advance instruction for MH treatment or confidential information from an advance instruction to a MD, psychologist or other qualified professional when the responsible professional determines that disclosure is necessary to give effect to or provide treatment in accordance with the advance instruction.”
Legally executed advance directive included the following:
1) Did the patient create the PAD while capable?
2) Is the PAD informed by present knowledge of risks and benefits?
3) Is a schizophrenic patient, who never achieved full remission, capable of making an informed reasoned judgement?
4) Was the patient adequately educated about the pros and cons of treatment, and the likelihood that the treatment can be carried out?
5) Was the surrogate decision maker adequately involved in the preparation of the PAD?
6) Was the patient coerced during the preparation of the PAD?
7) Is it possible that since the PAD was legalized, the patient changed their mind for reasons unrelated to delusional beliefs?
1) Can specific medication requests be honored?
2) Are the patient’s requests in the patient’s best interest medically?
3) Is there enough detailed instruction so that the patient’s request can be honored?
4) Are there adequate financial and medical resources available so that the requests can be instituted?
5) Is the surrogate decision-maker available?
6) Is there evidence that the patient’s preference for outpatient care has failed?
Will carrying out the treatment plan in light of PAD serve to foster patient cooperation or further damage the patient’s trust in health care providers?
Ways To Improve Usefulness of PADS to foster patient cooperation or further damage the patient’s trust in health care providers?