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Wednesday, October 3, 2018

Psychiatric Advance Directives (PAD) – are they different from a regular health care proxy?

Every individual of adult years and sound mind has a right to choose what shall be done with his own body and to control the course of his medical treatment. Patient autonomy and self-determination are a firmly ensconced principle in New York State Law.

But what happens with patients who have lost decision making capacity? A Health Care Proxy is a powerful tool. Patients may choose a health care agent who will make all health care decisions for them in the future. These decisions include both life-sustaining treatment and on-going medications.

Benefits of a Health Care Proxy include an ability to empower individuals in making their own treatment choices, enhance continuity of care, encourage treatment collaboration and communication between patient and family, and reduce the need for judicial intervention to compel treatment. The downsides are insufficient education regarding the role of a health care proxy amongst patients and lack of knowledge about required formalities of execution. According to recent studies, only about 1/3 of Americans have executed some kind of advance directive.

Psychiatric advance directives (PADs) were introduced as a means for people with psychiatric conditions to retain choice and control over their own mental health during periods when a person is temporarily unable to make informed choices. A PAD enables a person to specify what treatment should be administered or refused. A PAD must be accorded the same respect and consideration that a traditional advance directive for health care is given, even though there is a stigma associated with mental health issues.

Under New York law, a health care provider is obligated to comply with health care decisions made by an agent in good faith. While there is some uncertainty on the issue, in general the only time a health care proxy’s psychiatric directions can be overridden, is when a directive poses a direct threat to the health or safety of others, or when there is a direct threat to the patient’s life caused by a mental health emergency. Thus PADs can be a valuable tool in enhancing effectiveness of mental health treatments and avoiding the need for involuntary care.

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