RT Journal Article
SR Electronic
T1 Commentary: Psychiatric Advance Directives at a Crossroads—When Can PADs be Overridden?
JF Journal of the American Academy of Psychiatry and the Law Online
JO J Am Acad Psychiatry Law
FD American Academy of Psychiatry and the Law
SP 395
OP 397
VO 34
IS 3
A1 Paul S. Appelbaum
YR 2006
UL http://jaapl.org/content/34/3/395.abstract
AB Current statutes enabling psychiatric advance directives (PADs) typically include provisions allowing override of patients’ choices by treatment staff. Lest the purpose of the PAD be vitiated by too broad an application of the override mechanism, its use should be carefully limited. In inpatient settings, voluntary patients should have the right to decline treatments in advance, although not an absolute right to demand treatments of their choosing. The situation of involuntary patients is more complex. Permitting PADs to trump commitment statutes would undercut the combined parens patriae/police power rationale for commitment, a path taken currently by no U.S. jurisdiction. Moreover, PADs should not be permitted to negate the usual mechanisms for involuntary treatment of committed patients; to do otherwise risks forcing facilities to confine indefinitely persons they cannot treat. Even in those circumstances, however, where PADs provide evidence of reasonable patient preferences (e.g., for one medication over another), the choices they embody should be respected.