HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Srebnik, D. S. Articles by Kim, S. Y. Search for Related Content PubMed PubMed Citation Articles by Srebnik, D. S. Articles by Kim, S. Y.

Competency for Creation, Use, and Revocation of Psychiatric Advance Directives

Dr. Srebnik is Associate Clinical Professor, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA. Dr. Kim is Assistant Professor, Department of Psychiatry, Bioethics Program, and Center for Behavioral and Decision Sciences in Medicine, University of Michigan, Ann Arbor, MI. Address correspondence to: Debra S. Srebnik, PhD, Department of Psychiatry and Behavioral Sciences, University of Washington, Box 359911, 325 Ninth Avenue, Seattle, WA 98104. E-mail: srebnik{at}u.washington.edu

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.

This article has been cited by other articles:

				Bibliography for Ethics, Professionalism, and End of Life Care Focus, January 1, 2007; 5(4): 417 - 419. [Full Text] [PDF]