The longing for order: Oregon's medical advance directive for mental health treatment

Psychiatric Advance Directives: Perspectives of Community Stakeholders

“…The most frequently cited barriers included a lack of understanding of the documents, beliefs that psychiatric advance directives would have no impact on treatment, and uncertainly about what decisions one would outline in the advance directive. These concerns are consistent with those that have been articulated in the literature around the purpose, limitations, and applicability of the document; the determination of decision-making capacity; logistical issues; uncertainties about legal ramifications for following or refusing to follow advance directives; fears of the documents being used to validate involuntary treatment; and concerns about a possible loss of control and increased mistrust if the directives were not followed (Backlar, 1995;Backlar, 1997;Backlar & MacFarland, 1996;Fleischner, 1998;Geller, 2000;Hoge, 1994;R.C. Joondeph, unpublished;Sales, 1993;Srebnik & LaFond, 1999;Swanson et al, 2003).…”

Anticipatory Planning for Psychiatric Treatment: Liberty or Limitation for our Future Life Plans?

“…Our interest in maintaining control over our lives should we lose our capacity for decision-making became exemplified in 1991 with the implementation of the Patient Self-Determination Act (Omnibus Budget Reconciliation Act, 1990 (Greco et al, 1991). At that time, it was envisioned that an individual's engagement in health care planning for possible future events would prompt and enhance a dialogue between physicians and their patients, aid patients to be better informed, foster the appointment of surrogate decision makers, and aid individuals-who desired to end their lives with dignity-to escape from undesirable and non-beneficial protracted end-of-life treatment (Backlar, 1995;Backlar, 1997;Pearlman, 1994;President's Commission, 1983).…”

“…On the other side, for individuals who wished to be assured of treatment, some commentators proposed prior agreements that could be made for consent in advance (Rosenson & Kasten, 1991). Rogers and Centifanti (1991) made a middle ground proposal that offered choice and provided for both acceptance and rejection of psychiatric treatment (Backlar, 1995). In essence, psychiatric anticipatory planning was primarily conceived as a self-advocacy tool to benefit individuals under the special circumstances of a psychiatric emergency, i.e., presumably-but not with certainty-individuals would be able to retain control of their decisions about their treatment during a psychiatric crisis.…”

Advance Directives in Psychiatry

“…Since 1993 for instance, the law in Oregon enables citizens to draw up a declaration for mental health treatment that provides for consent to or refusal of treatment at a future time when a person may lack capacity to make such decisions. 19 More comprehensive legislation has been enacted in Minnesota. In 1991, its legistature passed an amendment to the state's psychiatric treatment laws creating an advance psychiatric directive.…”