Australian Psychiatrists' Support for Psychiatric Advance Directives: Responses to a Hypothetical Vignette

Abstract

This study examines whether Australian psychiatrists would support requests in a psychiatric advance directive (PAD) and the reasons underlying their decisions in response to a hypothetical vignette. An online survey was completed by 143 psychiatrists. Fewer than 3 out of 10 psychiatrists supported the patient to create a PAD which requested cessation of pharmacotherapy (27%) or remaining out of hospital and not being subject to an involuntary treatment order (24%) should their depression condition deteriorate. A thematic analysis showed that patient autonomy was the strongest theme among those who supported the patient to create a PAD, whereas the clinical profile of and risk to the patient and the professional or ethical imperative of the psychiatrist were strongest among those who were unsure about supporting the patient or who did not support the patient. These findings provide a challenge about how to fulfil obligations under the United Nations Convention on the Rights of Persons with Disabilities (2006).

Key words:

• advance directives
• advance care planning
• human rights
• international precedent
• law reform
• mental health
• psychiatry
• psychiatric advance directive

Acknowledgements

The authors acknowledge the members of the Advance Care Planning for Mental Health Treatment Reference Group, who contributed to the design of the materials used in this study. The group consisted of mental health clinicians, researchers and consumers.

Disclosure Statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was funded by the Australian Government's Department of Health under the National Palliative Care Program.