Overriding Psychiatric Advance Directives: Factors Associated with Psychiatrists' Decisions to Preempt Patients' Advance Refusal of Hospitalization and Medication |
| |
Authors: | Jeffrey W. Swanson S. Van McCrary Marvin S. Swartz Richard A. Van Dorn Eric B. Elbogen |
| |
Affiliation: | (1) Services Effectiveness Research Program in the Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Box 3071, Durham, North Carolina 27710, USA;(2) Division of Medicine in Society, Department of Preventive Medicine, School of Medicine, State University of New York at Stony Brook, New York, USA |
| |
Abstract: | Psychiatric advance directives (PADs) are intended to support patients' treatment decisions during a crisis. However, PAD statutes give clinicians broad discretion over whether to carry out patients' advance instructions. This study uses data from a survey of psychiatrists (N=164) to examine reasons for overriding PADs. In response to a hypothetical vignette, 47% of psychiatrists indicated that they would override a valid, competently-executed PAD that refused hospitalization and medication. PAD override was more likely among psychiatrists who worked in hospital emergency departments; those who were concerned about patients' violence risk and lack of insight; and those who were legally defensive. PAD override was less likely among participants who believed that involuntary treatment is largely unnecessary in a high-quality mental health system. |
| |
Keywords: | Psychiatric advance directives Severe mental illness Psychiatric disorders Mental health law |
本文献已被 PubMed SpringerLink 等数据库收录! |
|