title: Advance directives for psychiatric treatment: a view from the trenches.
abstract: Medical advance directives for end-of-life decisions at times that patients cannot express their preferences have become a major trend in recent state and federal legislation. The author argues that an extension of directives to cover future psychiatric treatment are fraught with both practical and ethical dilemmas. Although the potential for increasing patient autonomy is certainly positive, the potential for implementing covert ideological agendas has been present from the beginning, and the significant differences between medical end-of-life decisions and ongoing treatment of psychiatric patients must weigh against psychiatric advance directives unless major changes are made in existing procedures.
authors.affiliation: Department of Psychiatry, University of Colorado Health Sciences Center, 4200 East 9th Avenue, No. C249-27, Denver, Colorado 80262, USA.
authors.forename: R D
authors.initials: RD
authors.lastname: Miller
mesh_terms: D016223:Advance Directives / Q000331:legislation & jurisprudence*; D003134:Commitment of Persons with Psychiatric Disorders; D006801:Humans; D007258:Informed Consent; D016743:Mental Competency; D008605:Mental Health Services / Q000331:legislation & jurisprudence; D028642:Persons with Psychiatric Disorders; D026706:Paternalism; D026684:Personal Autonomy; D011329:Prisoners / Q000523:psychology; D016312:Treatment Refusal; D014481:United States