Psychiatric Advance Directive

By Psych Central Staff

A psychiatric advance directive, or PAD, allows patients with mental illness to state their preferences for, or dislikes of, specific treatments, designate a proxy decision-maker or make other advance decisions about their care.

Advance directives are based on the principles of personal choice and self-determination. The preferences you express regarding future treatment or services, a person you authorize to make decisions for you (a proxy), the ability to revoke your advance directive, or any other issues are for you to decide, without anyone exerting any control or coercion over you. You also have the right to change your mind and change your advance directive at any time, but it is your responsibility to make sure that all copies of the advance directive are kept up-to-date and copies are shared with the appropriate people.

This worksheet is not a legal document, but is designed to help you start thinking about what you want to include in your own advance directive. It can also help you start gathering the information you will need when you write one that is legally binding.

Your Expressed Wishes

An advance directive is your opportunity to express what treatments or services you choose to have, or not to have, during a psychiatric crisis. These statements are known as your expressed wishes. If you have ever been hospitalized before, think back about those things that were helpful to you, and those things that were not.

What types of treatments or services are helpful to you during a crisis? This can include medications (and dosages), what facilities or healthcare professionals you want to be involved in your care, what helps you calm down if you’re feeling overly agitated, who can help you in other ways (such as taking care of children, pets, plants, or paying bills), people you want as visitors if you’re hospitalized, etc. Try to be as specific as possible. You may need to use additional sheets of paper:

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

What types of treatments or services are NOT helpful to you during a crisis? This can include medications (and dosages) that you know will not be helpful, what facilities or healthcare professionals you wish to avoid, ways that people treat you that make you upset or angry, people who you don’t want to see if you are hospitalized, etc. Again, try to be as specific as possible:

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

Your Choice of Proxy

A healthcare proxy is someone who you authorize to make decisions for you at a time when you have been determined unable to make decisions for yourself. It’s important that you choose someone you trust and who you think will do a good job as your advocate. You may wish to choose one person as the primary agent, and choose a second person as a backup in case the first person is no longer able or willing to serve as your proxy.

1st Proxy’s Name:

_________________________________________________

Address:

_________________________________________________

City, State, and Zip:

_________________________________________________

Daytime Phone: (_______) _________ – __________________

Evening Phone: (_______) _________ – __________________

Mobile Phone: (_______) _________ – __________________

E-mail Address: _________________________________________________

2nd Proxy’s Name:

_________________________________________________

Address:

_________________________________________________

City, State, and Zip:

_________________________________________________

Daytime Phone: (_______) _________ – __________________

Evening Phone: (_______) _________ – __________________

Mobile Phone: (_______) _________ – __________________

E-mail Address: _________________________________________________

Your Choice of Revocability

Revocability is a controversial issue. Some individuals want to be able to revoke their advance directive even while they’re in crisis, possibly because they may change their minds about their expressed wishes or because they may become dissatisfied with the decisions their agent was making.

Other people know that they don’t make good decisions when they are in crisis, want the decisions they made ahead of time to apply throughout a crisis, and therefore want their advance directive to be irrevocable. Laws around revocability vary from state to state. Therefore, you will need to consult your state law before drafting these provisions.

If it is determined you are unable to make your own decisions, and you choose to revoke your advance directive at that time, your agent will no longer be able to advocate for your expressed wishes; you will lose the benefits of having an advance directive, and it will be as though you never had one. You may wish to discuss this issue with your friends, relatives and/or healthcare providers before you decide whether or not your advance directive should be revocable.

Please circle the answer that’s right for you:

Even if I were in the middle of a psychiatric crisis, I [ would | would not ] want to be able to revoke my advance directive.

Explanation of your choice of revocability, if you choose to give one:

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

Keep in mind that different states may have different legal requirements in order for it to be considered a legal document in that state. Check with an attorney or someone from your state’s protection and advocacy organization (www.protectionandadvocacy.com) for legal information specific to your state.

 

APA Reference
Psych Central. (2007). Psychiatric Advance Directive. Psych Central. Retrieved on November 28, 2014, from http://psychcentral.com/lib/psychiatric-advanced-directive/0001278
Scientifically Reviewed
    Last reviewed: By John M. Grohol, Psy.D. on 30 Jan 2013
    Published on PsychCentral.com. All rights reserved.

 

 

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