Advance directives in psychiatric care: a narrative approach.
Advance directives for psychiatric care are the subject of debate in a number of Western societies. By using psychiatric advance directives (or so-called "Ulysses contracts"), it would be possible for mentally ill persons who are competent and with their disease in remission, and who want timely intervention in case of future mental crisis, to give prior authorisation to treatment at a later time when they are incompetent, have become non-compliant, and are refusing care. Thus the devastating consequences of recurrent psychosis could be minimised. Ulysses contracts raise a number of ethical questions. In this article the central issues of concern and debate are discussed from a narrative perspective. Ulysses contracts are viewed as elements of an ongoing narrative in which patient and doctor try to make sense of and get a hold on the recurrent crises inherent in the patient's psychiatric condition.
Widdershoven
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Institute for Bioethics and Department of Health Ethics and Philosophy, Maastricht University, The Netherlands.
Berghmans
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D016223:Advance Directives; D032982:Contracts; D026690:Ethics, Clinical; D004992:Ethics, Medical; D006801:Humans; D007206:Individuality; D016743:Mental Competency; D001523:Mental Disorders / Q000523:psychology / Q000628:therapy; D028642:Persons with Psychiatric Disorders; D009426:Netherlands; D026684:Personal Autonomy; D011570:Psychiatry / Q000592:standards*; D016312:Treatment Refusal