1. Psychiatric advance directives under the Convention on the Rights of Persons with Disabilities: Why advance instructions should be able to override current preferences

    Scholten, M. A. Gieselmann J. Gather J. Vollmann 2019. Psychiatric advance directives under the Convention on the Rights of Persons with Disabilities: Why advance instructions should be able to override current preferences. Fron­tiers in Psych­ia­try 10 (631). https://doi.org/10.3389/fpsyt.2019.00631

    Psych­ia­tric ad­van­ce di­rec­ti­ves (PADs) are do­cu­ments by me­ans of which men­tal health ser­vice users can make known their pre­fe­ren­ces re­gar­ding treat­ment in a fu­ture men­tal health cri­sis. Many sta­tes with ex­pli­cit le­gal pro­vi­si­ons for PADs have ra­ti­fied the United Na­ti­ons (UN) Con­ven­ti­on on the Rights of Per­sons with Dis­abi­li­ties (CRPD). While im­por­tant UN bo­dies con­sider PADs a use­ful tool to pro­mo­te the au­to­no­my of ser­vice users, we show that an au­tho­ri­ta­ti­ve in­ter­pre­ta­ti­on of the CRPD by the Com­mit­tee on the Rights of Per­sons with Dis­abi­li­ties has the ad­ver­se con­se­quence of ren­de­ring PADs in­ef­fec­ti­ve in si­tua­ti­ons whe­re they could be of most use to ser­vice users. Ba­sed on two cli­ni­cal vi­gnet­tes, we de­mons­tra­te that rea­son­a­ble cli­ni­cal re­com­men­da­ti­ons can be de­ri­ved from a more rea­li­stic and fle­xi­ble CRPD mo­del. Con­cerns re­main about the ac­coun­ta­bi­li­ty of sup­port per­sons who give ef­fect to PADs. A mo­del that com­bi­nes sup­por­ted de­cis­i­on ma­king with com­pe­tence as­sess­ment is able to ad­dress the­se con­cerns.