J Am Acad Psychiatry Law 34:3:395-397 (2006)
Copyright © 2006 by the American Academy of Psychiatry and the Law.
Commentary: Psychiatric Advance Directives at a Crossroads—When Can PADs be Overridden?
Paul S. Appelbaum, MD
Dr. Appelbaum is Professor and Director, Division of Psychiatry, Law and Ethics, Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY.
Address correspondence to: Paul S. Appelbaum, MD, NY State Psychiatric Institute, 1051 Riverside Drive, #122, New York, NY 10032. E-mail: psa21{at}columbia.edu
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.
Copyright © 2006 by the American Academy of Psychiatry and the Law.
