title: Ethically Relevant Differences in Advance Directives for Psychiatric and End-of-Life Care.
abstract: BACKGROUND
  Psychiatric advance directives (PADs) represent a shift from more coercive to more recovery-oriented care and hold the promise of empowering patients while helping fill the gap in treatment of non-dangerous patients lacking decision-making capacity. Advance directives for end-of-life and psychiatric care share an underlying rationale of extending respect for patient autonomy and preventing the harm of unwanted treatment for patients lacking the decision-making capacity to participate meaningfully in planning their care.
  
  
  OBJECTIVE
  Ethically relevant differences in applying advance directives to end-of-life and psychiatric care are discussed.
  
  
  METHODS
  These differences fall into three categories: (1) patient factors, including decision-making capacity, ability to communicate, and prior experience; (2) decisional factors, including expected outcome and the nature of the decisions; and (3) historical-legal precedent.
  
  
  RESULTS
  Specific recommendations are offered.
  
  
  CONCLUSIONS
  Clinicians need to appreciate the ethical implications of these differences to effectively invoke PADs or assist patients in creating PADs.
authors.affiliation: Douglas P. Olsen, PhD, RN, Michigan State University College of Nursing, East Lansing, MI, USA douglas.olsen@hc.msu.edu.
authors.forename: Douglas P
authors.initials: DP
authors.lastname: Olsen
mesh_terms: D016223:Advance Directives / Q000941:ethics*; D003657:Decision Making; D006801:Humans; D016743:Mental Competency; D017410:Practice Guidelines as Topic; D011568:Psychiatric Nursing / Q000941:ethics* / Q000379:methods*; D013727:Terminal Care / Q000941:ethics* / Q000379:methods*
keywords: crisis; decision-making capacity; emergency; ethics; psychiatric advance directive