Thursday, December 13, 2018
The New York Times reported last week on psychiatric advance directives in Now Mental Health Patients Can Specify Their Care Before Hallucinations and Voices Overwhelm Them
"[A] psychiatric advance directive, a legal document declaring what treatment he does and doesn’t want. Increasingly, patients, advocates and doctors believe such directives (called PADs) could help transform the mental health system by allowing patients to shape their care even when they lose touch with reality. Hospitals must put them in patients’ medical records and doctors are expected to follow them unless they document that specific preferences aren’t in the patients’ best medical interest."
The article notes that not everyone is in favor of these. For example, "some doctors and hospitals are wary that the documents could tie their hands and discourage treatment they consider warranted. Some worry the directives won’t be updated to reflect medical advances. Others question whether people with serious psychiatric conditions are ever capable of lucidly completing such directives." The article notes that at least 27 states allow for the use of psychiatric advance directives-others may do so as part of the more traditional health care advance directive. The document is seen as an alternative to involuntary commitment.
CMS now requires health care providers to include in their inquiry about health care directives any psychiatric advance directive (see here requirements that hospitals ask if patients have a directive). The directive also allows advance permission by the patient for the health care providers to engage with friends or family, particularly important because during a crisis, the person may "be too unstable or paranoid to give permission." The article gives examples of what might be authorized by the directive, offers suggestions regarding drafting and signing and shares stories of some individuals who have created these directives.
On a side note, the article notes that the directives are referred to as PAD. On an unrelated topic, physician-aided dying is also sometimes shortened to PAD. Make sure your students understand the differences.