Psychiatric Advance Directives Under the Convention on the Rights of Persons With Disabilities: Why Advance Instructions Should Be Able to Override Current Preferences
Psychiatric advance directives (PADs) are documents by means of which mental health service users can make known their preferences regarding treatment in a future mental health crisis. Many states with explicit legal provisions for PADs have ratified the United Nations (UN) Convention on the Rights...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2019-09-01
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| Series: | Frontiers in Psychiatry |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/article/10.3389/fpsyt.2019.00631/full |
| _version_ | 1818433536525336576 |
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| author | Matthé Scholten Astrid Gieselmann Jakov Gather Jakov Gather Jochen Vollmann |
| author_facet | Matthé Scholten Astrid Gieselmann Jakov Gather Jakov Gather Jochen Vollmann |
| author_sort | Matthé Scholten |
| collection | DOAJ |
| description | Psychiatric advance directives (PADs) are documents by means of which mental health service users can make known their preferences regarding treatment in a future mental health crisis. Many states with explicit legal provisions for PADs have ratified the United Nations (UN) Convention on the Rights of Persons with Disabilities (CRPD). While important UN bodies consider PADs a useful tool to promote the autonomy of service users, we show that an authoritative interpretation of the CRPD by the Committee on the Rights of Persons with Disabilities has the adverse consequence of rendering PADs ineffective in situations where they could be of most use to service users. Based on two clinical vignettes, we demonstrate that reasonable clinical recommendations can be derived from a more realistic and flexible CRPD model. Concerns remain about the accountability of support persons who give effect to PADs. A model that combines supported decision making with competence assessment is able to address these concerns. |
| first_indexed | 2024-12-14T16:22:39Z |
| format | Article |
| id | doaj.art-c338a05929894ad8b3d9ec00bfbdf50f |
| institution | Directory Open Access Journal |
| issn | 1664-0640 |
| language | English |
| last_indexed | 2024-12-14T16:22:39Z |
| publishDate | 2019-09-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Psychiatry |
| spelling | doaj.art-c338a05929894ad8b3d9ec00bfbdf50f2022-12-21T22:54:46ZengFrontiers Media S.A.Frontiers in Psychiatry1664-06402019-09-011010.3389/fpsyt.2019.00631473001Psychiatric Advance Directives Under the Convention on the Rights of Persons With Disabilities: Why Advance Instructions Should Be Able to Override Current PreferencesMatthé Scholten0Astrid Gieselmann1Jakov Gather2Jakov Gather3Jochen Vollmann4Institute for Medical Ethics and History of Medicine, Ruhr University Bochum, Bochum, GermanyInstitute for Medical Ethics and History of Medicine, Ruhr University Bochum, Bochum, GermanyInstitute for Medical Ethics and History of Medicine, Ruhr University Bochum, Bochum, GermanyDepartment of Psychiatry, Psychotherapy, and Preventive Medicine, LWL University Hospital, Ruhr University Bochum, Bochum, GermanyInstitute for Medical Ethics and History of Medicine, Ruhr University Bochum, Bochum, GermanyPsychiatric advance directives (PADs) are documents by means of which mental health service users can make known their preferences regarding treatment in a future mental health crisis. Many states with explicit legal provisions for PADs have ratified the United Nations (UN) Convention on the Rights of Persons with Disabilities (CRPD). While important UN bodies consider PADs a useful tool to promote the autonomy of service users, we show that an authoritative interpretation of the CRPD by the Committee on the Rights of Persons with Disabilities has the adverse consequence of rendering PADs ineffective in situations where they could be of most use to service users. Based on two clinical vignettes, we demonstrate that reasonable clinical recommendations can be derived from a more realistic and flexible CRPD model. Concerns remain about the accountability of support persons who give effect to PADs. A model that combines supported decision making with competence assessment is able to address these concerns.https://www.frontiersin.org/article/10.3389/fpsyt.2019.00631/fullpsychiatric advance directivesadvance statementsUnited Nations Convention on the Rights of Persons with Disabilitiessubstitute decision makingsupported decision makinginformed consent |
| spellingShingle | Matthé Scholten Astrid Gieselmann Jakov Gather Jakov Gather Jochen Vollmann Psychiatric Advance Directives Under the Convention on the Rights of Persons With Disabilities: Why Advance Instructions Should Be Able to Override Current Preferences Frontiers in Psychiatry psychiatric advance directives advance statements United Nations Convention on the Rights of Persons with Disabilities substitute decision making supported decision making informed consent |
| title | Psychiatric Advance Directives Under the Convention on the Rights of Persons With Disabilities: Why Advance Instructions Should Be Able to Override Current Preferences |
| title_full | Psychiatric Advance Directives Under the Convention on the Rights of Persons With Disabilities: Why Advance Instructions Should Be Able to Override Current Preferences |
| title_fullStr | Psychiatric Advance Directives Under the Convention on the Rights of Persons With Disabilities: Why Advance Instructions Should Be Able to Override Current Preferences |
| title_full_unstemmed | Psychiatric Advance Directives Under the Convention on the Rights of Persons With Disabilities: Why Advance Instructions Should Be Able to Override Current Preferences |
| title_short | Psychiatric Advance Directives Under the Convention on the Rights of Persons With Disabilities: Why Advance Instructions Should Be Able to Override Current Preferences |
| title_sort | psychiatric advance directives under the convention on the rights of persons with disabilities why advance instructions should be able to override current preferences |
| topic | psychiatric advance directives advance statements United Nations Convention on the Rights of Persons with Disabilities substitute decision making supported decision making informed consent |
| url | https://www.frontiersin.org/article/10.3389/fpsyt.2019.00631/full |
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