Psychiatric advance decisions – an opportunity missed

After a very long gestation the Mental Capacity Bill was published earlier this year. Among its proposals was the incorporation into statute of advance decisions. These are devices whereby a person, while retaining capacity, can make certain decisions regarding their future treatment for such a time as they have lost capacity and so are unable to make legally binding decisions about their own treatment. As the Bill is phrased, advance decisions only permit a person to refuse treatment. There is no provision for that person to use ADs to express a positive preference for particular forms of treatment. It will be argued this represents a missed opportunity to allow patients and clinicians to engage in a more constructive approach to treatment planning. Experience from the USA demonstrates psychiatric advance directives have a role to play in engaging psychiatric patients and promoting adherence to their treatment plans.This paper will only address the use of AD in relation to mental health treatment, although it is recognised they have an application far wider than this, including decisions regarding life-sustaining treatment