PT  - JOURNAL ARTICLE
AU  - Debra S. Srebnik
AU  - Scott Y. Kim
TI  - Competency for Creation, Use, and Revocation of Psychiatric Advance Directives
DP  - 2006 Dec 01
TA  - Journal of the American Academy of Psychiatry and the Law Online
PG  - 501--510
VI  - 34
IP  - 4
4099  - http://jaapl.org/content/34/4/501.short
4100  - http://jaapl.org/content/34/4/501.full
SO  - J Am Acad Psychiatry Law2006 Dec 01; 34
AB  - Psychiatric advance directives help promote patient involvement in treatment and expedite psychiatric care. However, clinicians are unsure of how to use directives, partly due to poor clarity regarding standards for capacity to create, use, and revoke them. This article recommends possible capacity standards. Capacity to create directives is a legal presumption, supported by empirical data. Standards are discussed for the subset of cases in which capacity assessment is needed. Use of directives may be triggered by incapacity to provide informed consent to treatment, although tailored, individualized points of activation may also be considered. In many states, revocation of a psychiatric advance directive requires adequate decision‐making capacity. Setting a capacity standard for revocation presents challenges, however, in light of obstacles to providing treatment when revocation is attempted and the fact that many patients prefer revocable directives. As more directives are created and used, additional research and statutory refinements are warranted.