Psychiatric Advance Directives Under the Convention on the Rights of Persons With Disabilities: Why Advance Instructions Should Be Able to Override Current Preferences

Scholten, Matthé; Gieselmann, Astrid; Gather, Jakov; Vollmann, Jochen

doi:10.3389/fpsyt.2019.00631

Cited by 30 publications

(26 citation statements)

References 55 publications

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“…The directive is an instruction from the person that their "will" should be privileged over predicted "preferences" in the circumstances foreseen. 26,33 The person's autonomy (taken as the ability to form values and to act on those values) is thus to be respected. An intervention to give effect to the person's "will" could thus be justified.…”

Section: "Will and Preferences"mentioning

confidence: 99%

Involuntary Detention and Treatment: Are We Edging Toward a “Paradigm Shift”?

Szmukler

2020

Schizophrenia Bulletin

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Recent challenges to conventional mental health laws concerning involuntary detention and treatment of persons with a mental disorder have led to proposals, or indeed an insistence, that fundamental reform is necessary. A key theme has been the need to eliminate unfair discrimination against people with a mental disorder because their human rights are not respected on an equal basis with other people. Some proposals depart radically from conventional assumptions concerning the justification of involuntary detention and treatment. One is a “fusion law,” a generic law applying to all persons lacking the ability to make a treatment decision, whether resulting from a “mental” or “physical” illness. An authoritative interpretation of the UN Convention on the Rights of Persons with Disabilities (2006) goes so far as to maintain that involuntary interventions are a violation of the Convention.

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Section: "Will and Preferences"mentioning

confidence: 99%

Involuntary Detention and Treatment: Are We Edging Toward a “Paradigm Shift”?

Szmukler

2020

Schizophrenia Bulletin

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“…It has been reported that many bipolar disorder patients wish to plan care in advance of losing capacity, addressing self-binding issues as well as the request and refusal of treatment [29]. However, practicing advance directives planning in mental health to promote self-determination seems much more erratic than expected by patients and caregivers [30]. Although psychiatrists in this survey were positive about involving patients in healthcare planning, other researches show that most treatment discussion and decision making related to medication across patients with bipolar disorder and schizophrenia refers to stopping, reducing, continuing or changing medication, or deciding on a non-medication alternative, rather than discussing in advance the antipsychotics to be used in a crisis [31].…”

Section: Discussionmentioning

confidence: 99%

What Is the Capacity of Individuals with Schizophrenia and Bipolar Disorder to Make Healthcare Decisions? An Exploratory Study of the Views of Patients, Psychiatrists, and Family Caregivers—A Survey on Decisional Capacity in Mental Health

Pons

Calcedo‐Barba

Hastings

et al. 2021

Psychiatry International

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Background: Research on the decisional capacity of schizophrenia and bipolar disorder patients mostly reflects the hospital context. Aim: To describe the views of patients, psychiatrists, and caregivers on the capacity of individuals with schizophrenia and bipolar disorder to make everyday decisions on their care related to their illness. Methods: A survey was conducted among schizophrenia and bipolar disorder patients, psychiatrists, and caregivers (June 2019 to January 2020; seven countries). A questionnaire was emailed to members of the Global Alliance of Mental Illness of Advocacy Network—Europe (GAMIAN; patients) and the European Federation of Families of People with Mental Illness (EUFAMI; caregivers) and to psychiatrists who voluntarily agreed to participate. Questions referred to patients’ involvement and capacity for healthcare decision making, and to barriers to and opportunities for autonomous decision making. Frequency, agreement, and importance were rated on Likert scales. Descriptive statistics were conducted. Results: 21 schizophrenia or bipolar disorder patients (52.3% female; mean age (years) ± SD: 50.71 ± 12.02), 11 psychiatrists (18.2% female), and 15 caregivers (86.6% female; 100% family related) participated in the survey. In total, 86% of patients felt frequently involved in decisions about everyday care and medications, and 91% of psychiatrists and 40% of caregivers perceived the same; 38% of patients felt frequently involved in decisions about the use of acute symptom medications, and 57% on care planning, and 55% and 82% of psychiatrists, and 40% and 53% of caregivers, respectively, believed the same; and 86% of patients, 91% of psychiatrists, and 47% of caregivers agreed on the capacity of schizophrenia or bipolar disorder patients to value the implications of taking medicines to prevent acute psychotic crises. Poor understanding and training are barriers, while advocacy and increasing interest in patients’ needs are opportunities for increasing autonomous decision making. Conclusions: Stakeholders concur that schizophrenia and bipolar disorder patients have the capacity to make everyday decisions around their care related to their illness, including acute symptom management. Barriers and opportunities exist to foster autonomous decisions among mental illness individuals.

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“…Many countries now have legislative provisions for AS, seen by the Committee for the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) as an important step in meeting the Convention's aims of ensuring people with disabilities exercise their human rights (Scholten et al, 2019). States which have ratified the UNCRPD, including the United Kingdom, are required to "take appropriate measures to provide access by persons with disabilities to the support they may require in exercising their legal capacity" (UNCRPD, Article 12(3)), which AS are proposed to do (Stavert, 2015).…”

Section: Contextmentioning

confidence: 99%

Mental Health Professionals’ Positions in Relation to Advance Statements: A Foucauldian Discourse Analysis

et al. 2021

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Advance Statements enable mental health patients to have their preferences considered in treatment decisions in the event of losing capacity, but their uptake is poor. This is for complex and often conflicting reasons and factors related to service user, clinician, and institutional priorities, which influence clinical practice. A Foucauldian discourse analysis approach was used to explore how 13 mental health clinicians positioned their role in relation to Advance Statements. Five positions emerged from the data: taking account of peoples’ wishes, enabling people to have their say (to a point), we know what’s best, firefighting with risk, and leverage and liability. Discursive practices demonstrated and reinforced power relations between patients, clinicians, and wider systems. These findings highlight the challenge of legitimizing the knowledge of patients and need for a cultural shift at a systems level, which recognizes the ways Advance Statements meet the needs of all stakeholders.

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Psychiatric Advance Directives Under the Convention on the Rights of Persons With Disabilities: Why Advance Instructions Should Be Able to Override Current Preferences

Cited by 30 publications

References 55 publications

Involuntary Detention and Treatment: Are We Edging Toward a “Paradigm Shift”?

Involuntary Detention and Treatment: Are We Edging Toward a “Paradigm Shift”?

What Is the Capacity of Individuals with Schizophrenia and Bipolar Disorder to Make Healthcare Decisions? An Exploratory Study of the Views of Patients, Psychiatrists, and Family Caregivers—A Survey on Decisional Capacity in Mental Health

Mental Health Professionals’ Positions in Relation to Advance Statements: A Foucauldian Discourse Analysis

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