Advance directives for psychiatric patients? Balancing paternalism and autonomy.
Advance directives contain wishes and values, fears and refusals of competent lay people regarding medical interventions in future situations when they might lack communicative and decision-making capacities. However, these advance directives for medical, psychiatric and care interventions can very well be used to improve the care for patients in psychiatry and gerontopsychiatry and to provide individualized care and treatment. The development and use of advance-care documents in psychiatry, and the clinical and ethical appreciation and recognition of the wishes and values of those patients, represent a particularly difficult challenge to medical paternalism.
Centre of Medical Ethics, Ruhr University, Universitätsstrasse 150, 44780 Bochum, Germany. Med.Ethics@ruhr-uni-bochum.de
Hans-Martin
HM
Sass
D016223:Advance Directives / Q000331:legislation & jurisprudence*; D017028:Caregivers / Q000331:legislation & jurisprudence; D003704:Dementia / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D004992:Ethics, Medical; D005858:Germany; D006801:Humans; D007872:Legal Guardians; D008020:Life Support Care; D016743:Mental Competency / Q000331:legislation & jurisprudence*; D001523:Mental Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D026706:Paternalism; D010358:Patient Participation / Q000331:legislation & jurisprudence; D010817:Physician-Patient Relations; D016312:Treatment Refusal / Q000331:legislation & jurisprudence