Harvard Mental Health Letter

Making the most of psychiatric advance directives

Potential benefits, controversies, and why a team approach is best.

Few medical situations are as difficult as a psychiatric emergency. The fundamentals of providing quality care — talking about symptoms, reviewing medical history, making a diagnosis, prescribing treatment — may be impossible when a patient is delusional, psychotic, or otherwise incapacitated. Clinicians may find themselves wanting to elicit a patient's treatment preferences, but having to make quick decisions in order to provide emergency (and often lifesaving) care.

In theory, psychiatric advance directives provide a way to consider patient choice even during a medical crisis. These legal documents provide a mechanism for individuals to stipulate, in advance, what types of psychiatric treatments they prefer or to appoint a health care agent to make such decisions for them, should they become incapacitated.

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