Policy and Practice Reviews ARTICLE
Psychiatric advance directives under the Convention on the Rights of Persons with Disabilities
- 1Institute for Medical Ethics and History of Medicine, Ruhr University Bochum, Germany
- 2Department of Psychiatry, Psychotherapy and Preventive Medicine, University Hospitals of the Ruhr-University of Bochum, Germany
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 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 argue 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 show 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. We argue that therefore a model that combines supported decision-making with competence assessment is preferable.
Keywords: Psychiatric advance directives, Convention on the Rights of Persons with Disabilities (UNCRPD), supported decision-making, substitute decision making, competence, mental capacity, Joint crisis plans, Advance statements
Received: 17 May 2019;
Accepted: 05 Aug 2019.
Copyright: © 2019 Scholten, Gieselmann, Gather and Vollmann. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Dr. Matthé Scholten, Institute for Medical Ethics and History of Medicine, Ruhr University Bochum, Bochum, Germany, email@example.com