Overriding psychiatric advance directives: factors associated with psychiatrists' decisions to preempt patients' advance refusal of hospitalization and medication.

Full 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.

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Author information

Author/s: Swanson, Jeffrey W (JW); Van McCrary, S (S); Swartz, Marvin S (MS); Van Dorn, Richard A (RA); Elbogen, Eric B (EB);

Affiliation: Services Effectiveness Research Program, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Box 3071, Durham, North Carolina 27710, USA. jeffrey.swanson(-atsign-)duke.edu

Grants: K02-MH67864 (Agency:NIMH NIH HHS)

Journal and publication information

Publication Type: Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't

Journal: Law and human behavior (Law Hum Behav), published in United States. (Language: eng)

Reference: 2007-Feb; vol 31 (issue 1) : pp 77-90

Dates: Created 2007/02/23; Completed 2007/06/20; Revised 2007/12/03;

PMID: 16718578, status: MEDLINE (last retrieval date: 12/26/2008)

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Adult
Advance Directives - legislation & jurisprudence
Aged
Aged, 80 and over
Crisis Intervention - legislation & jurisprudence; statistics & numerical data
Decision Making
Drug Therapy - utilization
Female
Health Care Surveys
Hospitalization

Humans
Male
Mental Disorders - drug therapy; epidemiology; rehabilitation
Mental Health Services - legislation & jurisprudence; statistics & numerical data
Middle Aged
Physician-Patient Relations
Professional Autonomy
Psychiatry - legislation & jurisprudence; statistics & numerical data
Treatment Refusal
United States

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