Editor:
I read with interest and great appreciation the discussion1 and commentary2 concerning psychiatric advance directives (PADS) in the Journal. Many colleagues will be shocked to learn that the American Psychiatric Association Board of Trustees and Assembly have taken the concept beyond acceptable limits.
They recently approved a Position Statement on Mentally Ill Prisoners on Death Row that laudably calls for …the sentence of death to be reduced to a lesser punishment when the prisoner is found to have a mental disorder or disability that significantly impairs his or her capacity to understand the nature and purpose of the punishment, or to appreciate the reason for its imposition in the prisoner's own case.
However, in its Commentary, the Statement expresses the view that it is ethical to treat an incompetent death row inmate to render him competent to be executed when that inmate, at a time when he was competent, had made out an advance directive that he be treated should he become incompetent. The purported intent of the APA Statement is to respect the dignity and autonomy of the prisoner by honoring his wish to be executed.
I consider such treatment as carrying autonomy beyond its legitimate interests. To comply in such a request, the physician is cooperating formally with an act that is intrinsically wrong—namely, any active, direct cooperation by a physician in the act of execution. I believe that the Board inadvertently took a position that constitutes APA participation in executions in violation of the code of medical ethics.
- American Academy of Psychiatry and the Law
