By Tania Gerbel | Slate
When people hear the term “advance directive,” they usually think about end-of-life situations—like a living will in which you give instructions for how you would like things to be managed if you were terminally ill. Most commonly this will take the form of advance refusals of particular treatments that might delay death without making life comfortable.
Now, this idea of giving advance medical instructions for a future when you might not be able to make decisions for yourself is gaining prominence within a very different health context: helping people with severe mental illness manage their own care. In many ways, mental illness provides the perfect opportunity for advance decision-making.
With terminal or degenerative illnesses such as dementia, a common concern is that people are thinking themselves into a future context, one where they have no experience and cannot necessarily anticipate what their wishes and preferences would be. By contrast, severe mental illnesses—such as bipolar, major depression, and psychosis—are often episodic and repetitive. Based on past experience, people know how things are likely to be when they are unwell. They also have periods of wellness and stability in between episodes of illness when they are able to reflect on this and make decisions about future treatment. Advance directives are all about maximizing the individual’s autonomy by allowing them to make decisions and exert control over how their treatment is managed when illness takes away their ability to do this. In the words of the eminent U.S. psychiatrist Allen Frances, “Advance directives are perhaps the only intervention in psychiatry that is without a downside.”
“This article presents a creative solution to take better control of your health care decisions. As we gain knowledge and awareness about ourselves, our medical conditions and what treatments work best for a given situation, an advance directive could provide a useful roadmap for others to assist with our care when we are not able. Rather than leave decisions up to others if we are incapacitated or subject to our own irrational thoughts while in a difficult state of mind, a directive provides a path to better control your treatment decisions. As described in the article, there are a myriad of potential situations where this type of tool will be advantageous. While these types of directives should only be created when having a clear mind and an understanding of the treatment options, planning ahead and documenting what works best for you can give you a major role in your treatment when you are not in a position to speak for yourself.”
Tony Freeman, Rose Law Group Senior Counsel
