PT  - JOURNAL ARTICLE
AU  - George Szmukler
AU  - John Dawson
TI  - Commentary: Toward Resolving Some Dilemmas Concerning Psychiatric Advance Directives
DP  - 2006 Sep 01
TA  - Journal of the American Academy of Psychiatry and the Law Online
PG  - 398--401
VI  - 34
IP  - 3
4099  - http://jaapl.org/content/34/3/398.short
4100  - http://jaapl.org/content/34/3/398.full
SO  - J Am Acad Psychiatry Law2006 Sep 01; 34
AB  - Dilemmas about when psychiatric advance directives (PADs) should be overridden are complicated by conflicting legal frameworks that may nonetheless operate concurrently—a legal scheme based on decision-making capacity (or competency) set against a legal scheme based on civil commitment, in which the latter may “trump” the former. A single statute in which the strengths of both schemes are “fused” may be possible. There is evidence that the promise of PADs in enhancing patients’ control over their treatment can be achieved without legislation for PADs and where civil commitment is given legal precedence. An example is the “joint crisis plan” in which, through a negotiation facilitated by an independent third party, a joint agreement is reached between patient and service provider about what treatment should be given when, as a result of a relapse of mental illness, the patient loses the ability to make treatment decisions. This clinical instrument may significantly reduce later involuntary treatment.