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Advance Directives pp 37–49Cite as

Advance Directives in Psychiatry

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Part of the book series: International Library of Ethics, Law, and the New Medicine ((LIME,volume 54))

Abstract

Advance directives are regulated by legislation in many countries. This chapter discusses ethical challenges posed by advance directives in patients with mental disorders. Besides information on treatment preferences for specific clinical situations, the patient’s mental capacity at the time of writing a directive is an essential factor. Challenges associated with different concepts of competence are presented, as well as empirical data concerning clinical assessment of mental capacity in psychiatry. Also discussed are the “Decisional Competence Assessment Tool for Psychiatric Advance Directives” and empirical studies from the US on how advance directives in patients with mental disorders are rated by attending psychiatrists. Ethical conclusions are drawn for the handling of advance directives in psychiatric practice.

Parts of this chapter were originally published in: Vollmann J: Patientenverfügungen von Menschen mit psychischen Störungen. Gültigkeit, Reichweite, Wirksamkeitsvoraussetzung und klinische Umsetzung [Advance directives in patients with mental disorders. Scope, prerequisites for validity and clinical implementation] Der Nervenarzt 83:25–30 (2012).

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References

  • Appelbaum, Paul S. 1991. Advance directives for psychiatric treatment. Hospital & Community Psychiatry 42: 983–984.

    CAS  Google Scholar 

  • Appelbaum, Paul S. 2004. Psychiatric advance directives and the treatment of committed patients. Psychiatric Services 55: 751–752, 763.

    Article  PubMed  Google Scholar 

  • Appelbaum, Paul S., S.A. Mirkin, and A.L. Bateman. 1981. Empirical assessment of competency to consent to psychiatric hospitalization. The American Journal of Psychiatry 138: 1170–1176.

    PubMed  CAS  Google Scholar 

  • Appelbaum, Paul S., Thomas Grisso, Ellen Frank, Sandra O’Donnell, and David J. Kupfer. 1999. Competence of depressed patients for consent to research. The American Journal of Psychiatry 156: 1380–1384.

    PubMed  CAS  Google Scholar 

  • Bauer, Armin, and Jochen Vollmann. 2002. Einwilligungsfähigkeit bei psychisch Kranken Eine Übersicht empirischer Untersuchungen. Der Nervenarzt 73: 1031–1038.

    Article  PubMed  CAS  Google Scholar 

  • Bean, G., S. Nishisato, N.A. Rector, and G. Glancy. 1994. The psychometric properties of the Competency Interview Schedule. Canadian Journal of Psychiatry 39: 368–376.

    CAS  Google Scholar 

  • Beauchamp, Tom L., and James F. Childress. 1994. Principles of biomedical ethics. New York: Oxford University Press.

    Google Scholar 

  • Breden, Torsten M., and Jochen Vollmann. 2004. The cognitive based approach of capacity assessment in psychiatry: A philosophical critique of the MacCAT-T. Health Care Analysis 12(4): 273–283; discussion 265–272.

    Article  PubMed  Google Scholar 

  • Burchardi, Nicole, Oliver Rauprich, and Jochen Vollmann. 2005a. Patientenverfügungen in der hausärztlichen Betreuung von Patienten am Lebensende. Palliativmedizin 6(02): 65–69.

    Article  Google Scholar 

  • Burchardi, Nicole, Oliver Rauprich, Martin Hecht, Marcus Beck, and Jochen Vollmann. 2005b. Discussing living wills. A qualitative study of a German sample of neurologists and ALS patients. Journal of the Neurological Sciences 237(1–2): 67–74.

    Article  PubMed  Google Scholar 

  • Carpenter, William T., James M. Gold, Adrienne C. Lahti, Caleb A. Queern, Robert R. Conley, Robert J. Bartko, Jeffrey Kovnick, and Paul S. Appelbaum. 2000. Decisional capacity for informed consent in schizophrenia research. Archives of General Psychiatry 57: 533–538.

    Article  PubMed  Google Scholar 

  • Charland, Louis C. 1998. Appreciation and emotion: Theoretical reflections on the MacArthur Treatment Competence Study. Kennedy Institute of Ethics Journal 8: 359–376.

    Article  PubMed  Google Scholar 

  • Deutsche Gesellschaft für Psychiatrie, Psychotherapie und Nervenheilkunde. 2009. Für Patientenautonomie und ärztliche Fürsorge in der Psychiatrie. DGPPN: Stellungnahme zur Anhörung im Deutschen Bundestag über Patientenrechte und Patientenverfügungen. 3/03.03.2009. http://www.dgppn.de/fileadmin/user_upload/_medien/download/pdf/pressemitteilungen/2009/pm-2009-03-patientenautonomie.pdf. Accessed 25 Nov 2010.

  • Deutsche Gesellschaft für Psychiatrie, Psychotherapie und Nervenheilkunde. 2010. Auswirkungen des Betreuungsrechtsänderungsgesetzes (Patientenverfügungsgesetz) auf die medizinische Versorgung psychisch Kranker: Rechtsgutachten und Stellungnahme der DGPPN. 3 / 15.04.2010. http://www.dgppn.de/fileadmin/user_upload/_medien/download/pdf/stellungnahmen/2010/stn-2010-04-15-patientenverfuegung.pdf. Accessed 25 Nov 2010.

  • Elbogen, Eric B., Jeffrey W. Swanson, Paul S. Appelbaum, Marvin S. Swartz, Joelle Ferron, Richard A. Van Dorn, and H. Ryan Wagner. 2007. Competence to complete psychiatric advance directives: Effects of facilitated decision making. Law and Human Behavior 31(3): 275–289.

    Article  PubMed  Google Scholar 

  • Elliot, Carl. 1997. Caring about risks: Are severely depressed patients competent to consent to research? Archives of General Psychiatry 54: 113–116.

    Article  Google Scholar 

  • Emanuel, Linda L., Ezekiel J. Emanuel, John D. Stoeckle, Lacinda R. Hummel, and Michael J. Barry. 1994. Advance directives. Stability of patients’ treatment choices. Archives of Internal Medicine 154(2): 209–217.

    Article  PubMed  CAS  Google Scholar 

  • Finzen, Asmus. 2009. Ende der Zwangspsychiatrie? Das neue Gesetz zur Patientenverfügung erweitert den Vorsorgespielraum psychisch Kranker. Psychosoziale Umschau 04: 26.

    Google Scholar 

  • Fritze, Jürgen, and Hans-Martin Sass. 2003. Patientenrechte, Patientenverfügung, Vorsorgevollmacht. Der Nervenarzt 74(7): 629–631.

    Article  PubMed  CAS  Google Scholar 

  • Grisso, Thomas, and Paul S. Appelbaum. 1995. Comparison of standards for assessing patients’ capacities to make treatment decisions. The American Journal of Psychiatry 152: 1033–1037.

    PubMed  CAS  Google Scholar 

  • Grisso, Thomas, and Paul S. Appelbaum. 1998. Assessing competence to consent to treatment: A guide for physicians and other health professionals. New York: Oxford University Press.

    Google Scholar 

  • Grisso, Thomas, Paul S. Appelbaum, and Carolyn Hill-Fotouhi. 1997. The MacCAT-T: A clinical tool to assess patients’ capacities to make treatment decisions. Psychiatric Services 48: 1415–1419.

    PubMed  CAS  Google Scholar 

  • Grossman, L., and F. Summers. 1980. A study of the capacity of schizophrenic patients to give informed consent. Hospital & Community Psychiatry 31: 205–206.

    CAS  Google Scholar 

  • Hansen, H.C., R. Drews, and P.W. Gaidzik. 2008. Zwischen Patientenautonomie und ärztlicher Garantenstellung. Die Frage der Einwilligung von Patienten mit Bewusstseinsstörungen. Der Nervenarzt 79(6): 706–715.

    Article  PubMed  Google Scholar 

  • Haupt, M., H. Seeber, and M. Janner. 1999. Patientenverfügungen und Bevollmächtigungen in gesundheitlichen Angelegenheiten älterer psychisch kranker Menschen. Der Nervenarzt 70(3): 256–261.

    Article  PubMed  CAS  Google Scholar 

  • Helmchen, Hanfried. 1998. Research with patients incompetent to give informed consent. Current Opinion in Psychiatry 11: 295–297.

    Article  Google Scholar 

  • Helmchen, Hanfried, and Hans Lauter. 1995. Dürfen Ärzte mit Demenzkranken forschen? Analyse des Problemfeldes Forschungsbedarf und Einwilligungsproblematik. Stuttgart: Thieme.

    Google Scholar 

  • Hoffman, B.F., and J. Srinivasan. 1992. A study of competence to consent to treatment in a psychiatric hospital. Canadian Journal of Psychiatry 37: 179–182.

    CAS  Google Scholar 

  • Honberg, Ronald S. 2010. Advance directives. http://www.nami.org/Content/ContentGroups/Legal/Advance_Directives.htm. Accessed 16 June 2010.

  • Janofsky, Jeffrey S., Richard J. McCarthy, and Marshal F. Folstein. 1992. The Hopkins competency assessment test: A brief method for evaluating patients’ capacity to give informed consent. Hospital & Community Psychiatry 43: 132–136.

    CAS  Google Scholar 

  • Kim, Scott Y.H., Eric D. Caine, Glenn W. Currier, Adrian Leibovici, and J. Michael Ryan. 2001. Assessing the competence of persons with Alzheimer’s disease in providing informed consent for participation in research. The American Journal of Psychiatry 158: 712–717.

    Article  PubMed  CAS  Google Scholar 

  • Kitamura, Fusako, Atsuko Tomoda, Kazumi Tsukada, Makoto Tanaka, Ikuko Kawakami, Shuuichi Mishima, and Toshinori Kitamura. 1998. Method for assessment of competency to consent in the mentally ill: Rationale, development, and comparison with the medically ill. International Journal of Law and Psychiatry 21: 223–244.

    Article  PubMed  CAS  Google Scholar 

  • Koch, Hans-Georg, Stella Reiter-Theil, and Hanfried Helmchen. 1996. Informed consent in psychiatry. European perspectives of ethics, law and clinical practise. Baden-Baden: Nomos.

    Google Scholar 

  • Lang-Welzenbach, Marga, Peter A. Fasching, and Jochen Vollmann. 2005. Patientenverfügungen und Therapieentscheidungen in der gynäkologischen Onkologie – Qualitative Interviews mit Patientinnen, Ärzten und Pflegepersonal. Geburtshilfe und Frauenheilkunde 65(05): 494–499.

    Article  Google Scholar 

  • Lauter, Hans, and Hanfried Helmchen. 2006. Vorausverfügter Behandlungsverzicht bei Verlust der Selbstbestimmtbarkeit infolge persistierender Hirnerkrankungen. Der Nervenarzt 77(9): 1031–1039.

    Article  PubMed  CAS  Google Scholar 

  • Lipp, Volker. 2009. Handbuch der Vorsorgeverfügungen: Vorsorgevollmacht – Patientenverfügung – Betreuungsverfügung. München: Vahler.

    Google Scholar 

  • Mahler, John, and Samuel Perry. 1988. Assessing competency in the physically ill: Guidelines for psychiatric consultants. Hospital & Community Psychiatry 39: 856–861.

    CAS  Google Scholar 

  • Markson, L.J., D.C. Kern, G.J. Annas, and L.H. Glantz. 1994. Physician assessment of patient competence. Journal of the American Geriatrics Society 42: 1074–1080.

    PubMed  CAS  Google Scholar 

  • Marson, Daniel C., Kellie K. Ingram, Heather A. Cody, and Lindy E. Harrell. 1995. Assessing the competency of patients with Alzheimer’s disease under different legal standards. A prototype instrument. Archives of Neurology 52: 949–954.

    Article  PubMed  CAS  Google Scholar 

  • Marson, Daniel C., Anjan Chatterjee, Kellie K. Ingram, and Lindy E. Harrell. 1996. Toward a neurologic model of competency: Cognitive predictors of capacity to consent in Alzheimer’s disease using three different legal standards. Neurology 46: 666–672.

    Article  PubMed  CAS  Google Scholar 

  • Marson, D.C., B. McInturff, L. Hawkins, A. Bartolucci, and L.E. Harrell. 1997. Consistency of physician judgements of capacity to consent in mild Alzheimer’s disease. Journal of the American Geriatrics Society 45: 453–457.

    PubMed  CAS  Google Scholar 

  • McKinnon, Karen, Karen Cournos, and Barbara Stanley. 1989. Rivers in practice: Clinicians’ assessment of patients decision-making capacity. Hospital & Community Psychiatry 40: 1159–1162.

    CAS  Google Scholar 

  • National Resource Center on Psychiatric Advance Directives. 2010. Homepage. http://www.nrc-pad.org. Accessed 16 June 2010.

  • Nationaler Ethikrat. 2005. Patientenverfügung. Berlin: Nationaler Ethikrat.

    Google Scholar 

  • Olzen, Dirk, Eylem Kaya, Angela Metzmacher, and Noëlly Zink. 2009. Die Auswirkungen des Betreungsrechtsänderungsgesetzes (Patienteverfügungsgesetz) auf die medizinische Versorgung psychisch Kranker. Gutachten für die Deutsche Gesellschaft für Psychiatrie. Berlin: Psychotherapie und Nervenheilkunde.

    Google Scholar 

  • Roth, Loren H. 1983. Is it best to obtain informed consent from schizophrenic patients about the possible risk of drug treatment, for example, tardive dyskinesia, before initiating treatment or at a later date? Journal of Clinical Psychopharmacology 3: 207–208.

    Article  PubMed  CAS  Google Scholar 

  • Rutman, D., and M. Silberfeld. 1997. A preliminary report on the discrepancy between clinical and test evaluation of competence. Canadian Journal of Psychiatry 37: 634–639.

    Google Scholar 

  • Sass, Hans-Martin, and Rita Kielstein. 2001. Patientenverfügung und Betreuungsvollmacht. Münster: Lit Verlag.

    Google Scholar 

  • Srebnik, Debra S., Lindsay T. Rutherford, Tracy Peto, Joan Russo, Ellen Zick, Craig Jaffe, and Paul Holtzheimer. 2005. The content and clinical utility of psychiatric advance directives. Psychiatric Services 56: 592–598.

    Article  PubMed  Google Scholar 

  • Swanson, Jeffrey W., S. Van McCrary, Marvin S. Swartz, Eric B. Elbogen, and Richard A. Van Dorn. 2006a. Superseding psychiatric advance directives: Ethical and legal considerations. The Journal of the American Academy of Psychiatry and the Law 34: 385–394.

    PubMed  Google Scholar 

  • Swanson, Jeffrey W., Marvin S. Swartz, Eric B. Elbogen, Richard A. Van Dorn, H. Joelle Ferron, Ryan Wagner, Barbara J. McCauley, and Mimi Kim. 2006b. Facilitated psychiatric advance directives: A randomized trial of an intervention to foster advance treatment planning among persons with severe mental illness. The American Journal of Psychiatry 163: 1943–1951.

    Article  PubMed  Google Scholar 

  • Swartz, Marvin S., J.W. Swanson, R.A. Van Dorn, Eric E. Elbogen, and Martha Shumway. 2006. Patient preferences for psychiatric advance directives. International Journal of Forensic Mental Health 5: 67–81.

    Article  Google Scholar 

  • Vollmann, Jochen. 2000a. Chancen und Risiken von Patientenverfügungen bei dementiellen Störungen. Zeitschrift für Gerontopsychologie und -psychiatrie 13(1): 38–50.

    Article  Google Scholar 

  • Vollmann, Jochen. 2000b. Aufklärung und Einwilligung in der Psychiatrie. Ein Beitrag zur Ethik in der Medizin. Darmstadt: Steinkopff.

    Book  Google Scholar 

  • Vollmann, Jochen. 2000c. Einwilligungsfähigkeit als relationales Modell. Klinische Praxis und medizinethische analyse. Der Nervenarzt 71(9): 709–714.

    Article  PubMed  CAS  Google Scholar 

  • Vollmann, Jochen. 2008. Patientenselbstbestimmung und Selbstbestimmungsfähigkeit. Beiträge zur Klinischen Ethik. Stuttgart: Kohlhammer.

    Google Scholar 

  • Vollmann, Jochen. 2010. Leserbrief zu Kartin Zeug “Nicht gegen meinen Willen” (ZEIT Nr. 37–2010). ZEIT 65(39): 95.

    Google Scholar 

  • Vollmann, Jochen, and Irene Knöchel-Schiffer. 1999. Patientenverfügungen in der klinischen Praxis. Medizinische Klinik 94(7): 398–405.

    Article  PubMed  CAS  Google Scholar 

  • Vollmann, Jochen, and Michael Pfaff. 2003. Patientenverfügungen: Theoretische Konzeption und praktische Bedeutung in den USA. Deutsche Medizinische Wochenschrift 128(27): 1494–1497.

    Article  PubMed  CAS  Google Scholar 

  • Vollmann, Jochen, Armin Bauer, Heidi Danker-Hopfe, and Hanfried Helmchen. 2003. Competence of mentally ill patients: A comparative empirical study. Psychological Medicine 33(8): 1463–1471.

    Article  PubMed  CAS  Google Scholar 

  • Vollmann, Jochen, Klaus-Peter Kühl, Amely Tilmann, Heinz-Dieter Hartung, and Hanfried Helmchen. 2004. Einwilligungsfähigkeit und neuropsychologische Einschränkungen bei dementen Patienten. Der Nervenarzt 75(1): 29–35.

    Article  PubMed  CAS  Google Scholar 

  • Welie, Sander P.K. 2001. Criteria for patient decision making (in)competence: A review of and commentary on some empirical approaches. Medicine Health Care and Philosophy 4: 139–151.

    Article  CAS  Google Scholar 

  • Wilder, Christine M., Eric B. Elbogen, Marvin S. Swartz, Jeffrey W. Swanson, and Richard A. Van Dorn. 2007. Effect of patients’ reasons for refusing treatment on implementing psychiatric advance directives. Psychiatric Services 58: 1348–1350.

    Article  PubMed  Google Scholar 

  • Wittink, Marsha N., Knashawn H. Morales, Lucy A. Meoni, Daniel E. Ford, Nae-Yuh Wang, Michael J. Klag, and Joseph J. Gallo. 2008. Stability of preferences for end-of-life treatment after 3 years of follow-up: The Johns Hopkins Precursors Study. Archives of Internal Medicine 168(19): 2125–2130.

    Article  PubMed  Google Scholar 

  • Zeug, Katrin. 2010. Nicht gegen meinen Willen. ZEIT 37–2010: 38.

    Google Scholar 

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Authors and Affiliations

  1. Institute for Medical Ethics and History of Medicine, Ruhr-Universität Bochum, Markstraße 258a, 44799, Bochum, Germany

    Jochen Vollmann

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  1. Jochen Vollmann
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Correspondence to Jochen Vollmann .

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Editors and Affiliations

  1. Department of Moral Theology and Ethics, University of Fribourg, Basel, Switzerland

    Peter Lack

  2. Institute of Biomedical Ethics, University of Zurich, Zurich, Switzerland

    Nikola Biller-Andorno

  3. Institute of Biomedical Ethics, University of Zurich, Zurich, Switzerland

    Susanne Brauer

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Vollmann, J. (2014). Advance Directives in Psychiatry. In: Lack, P., Biller-Andorno, N., Brauer, S. (eds) Advance Directives. International Library of Ethics, Law, and the New Medicine, vol 54. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-7377-6_3

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