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J Am Acad Psychiatry Law 34:3:398-401 (2006)
Copyright © 2006 by the American Academy of Psychiatry and the Law.
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ANALYSIS AND COMMENTARY

Commentary: Toward Resolving Some Dilemmas Concerning Psychiatric Advance Directives

George Szmukler, MB, BS, MD, FRCPsych and John Dawson, LLM

George Szmukler is Dean, Institute of Psychiatry, King’s College London, and Consultant Psychiatrist, South London and Maudsley NHS Trust, London, UK. Mr. Dawson is Professor of Law, Faculty of Law, University of Otago, Dunedin, New Zealand. Address correspondence to: George Szmukler, MB, BS, MD, FRCPsych, Institute of Psychiatry, King’s College London, De Crespigny Park, London SE5 8AF, UK. E-mail: g.szmukler{at}iop.kcl.ac.uk

Dilemmas about when psychiatric advance directives (PADs) should be overridden are complicated by conflicting legal frameworks that may nonetheless operate concurrently—a legal scheme based on decision-making capacity (or competency) set against a legal scheme based on civil commitment, in which the latter may "trump" the former. A single statute in which the strengths of both schemes are "fused" may be possible. There is evidence that the promise of PADs in enhancing patients’ control over their treatment can be achieved without legislation for PADs and where civil commitment is given legal precedence. An example is the "joint crisis plan" in which, through a negotiation facilitated by an independent third party, a joint agreement is reached between patient and service provider about what treatment should be given when, as a result of a relapse of mental illness, the patient loses the ability to make treatment decisions. This clinical instrument may significantly reduce later involuntary treatment.






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Copyright © 2006 by the American Academy of Psychiatry and the Law.