Advance Directives and the Treatment of Patients with Mental Illness: Can an Advance Directive Avert Court Intervention When the Patient Refuses the Administration of Antipsychotic Medication?

Abstract

This article reviews the use of advance directives in the treatment of mental illness and finds that they hold untapped potential to improve outcomes while reducing time spent in court and damage to the physician–patient relationship resulting from litigation. Most state advance-directives laws apply to mental health treatment. However, their use in the treatment of mental illness has lagged behind their use in other medical conditions. Although there are unique risks to the use of advance directives in treating mental illness, they retain a legitimacy and persuasiveness in the wake of a later rejection by an impaired-capacity patient. Concerns that patients will seek to override directives or to use them to affirmatively refuse later treatment can largely be overcome; however, their possible use to avoid later treatment underscores the need for state law protections to ensure a patient's competency at the time the proxy is signed. Anecdotal evidence suggests that advance directives hold value in psychiatry. Clinicians need to explore their use before an assessment can be made of whether the overall success of advance directives will carry over to the treatment of mental illness.