Ulysses arrangements in psychiatry: a matter of good care?

Abstract

This article concerns the issue of how an ethic of care perspective may contribute to both normative theory and mental health care policy discussions on so called Ulysses arrangements, a special type of advance directives in psychiatry. The debate on Ulysses arrangements has predominantly been waged in terms of autonomy conceived of as the right to non-intervention. On the basis of our empirical investigations into the experiences of persons directly involved with Ulysses arrangements, we argue that a care ethics perspective may broaden and deepen the debate on Ulysses arrangements, by introducing additional concepts, such as vulnerability, responsibility and mutuality, and by refining familiar concepts, such as autonomy.

Fluctuating capacity and advance decision-making in Bipolar Affective Disorder — Self-binding directives and self-determination

“…A frequently cited aim of PADs in general is to reduce the need for coercion through, for example, improving crisis management recommendations based on patients' past experiences and preferences ( Henderson et al, 2004; Khazaal, Chatton, Pasandin, Zullino, & Preisig, 2009; Swanson et al, 2008; Thornicroft et al, 2013 ). By contrast, a primary outcome of SBDs is to enable the individual to request introduction of coercive interventions in the earlier stages of illness, in order to prevent themselves from engaging in damaging and risky behaviour as they deteriorate ( Gremmen, Widdershoven, Beekman, Zuijderhoudt, & Sevenhuijsen, 2008 ). Within the context of broad concerns about psychiatric coercion and current interpretations of the CRPD, which reject entirely judgements of incapacity and use of coercion (2014), this central coercive aspect of SBDs might seem problematic.…”

Sterilization of men with intellectual disabilities

“…113 This would represent a shift from an individualistic paradigm towards a relational paradigm. 114 The promotion of close relationships may underlie individual interests, and this idea certainly accords with the judicial trend in asserting that best interest not be confined to purely 'medical' but to incorporate a 'wide range of ethical, social, moral, emotional and welfare considerations', 115 which Herring argues could include 'obligations towards others'. 116 It is possible that care ethics gives a balanced view to take account of carers' interests as enhancing the individual's interests, and certainly, it was beyond dispute that both A and DE were very close to and well cared for by their parents.…”

Ulysses Contracts in psychiatric care: helping patients to protect themselves from spiralling

“…The contract must also contain detailed explanations of their motivations for the contract, acknowledging their most meaningful values, desires, and goals for the future. The agent must take responsibility for the consequences of the arrangement, have a full understanding and awareness of the seriousness of a Ulysses Contract, and must experience no pressure or coercion from others to make the commitment [22].…”

“…For example, as U C most important concerns. Gremmen et al carried out interviews on people who have Ulysses C [22], and helped them to gain insight into their illness and potential ways they could avert the need for coercive intervention. In addition, there is also empirical support indicating that earlier intervention leads to a shorter and less intense period of recovery compared to the recovery period which would likely follow a relapse.…”