The impact of psychiatric advance directives on informed consent

Informed consent ensures patients' decisions are based on a full understanding of their medical condition and treatment options. In situations where psychiatric advance directives are activated, patients may be unable to provide consent. In these cases, practitioners can receive guidance from proxies and use their best judgment on medical care. 

What is a psychiatric advance directive? 

A psychiatric advance directive is a document for individuals with mental health conditions, outlining their treatment preferences in case of a crisis. Psychiatry Online explains, “They can be created by the service user alone or with the support of at least one other person. The latter are often referred to as facilitated PADs.”

While similar to medical directives, psychiatric advance directives specifically cover mental health topics.  

Psychiatric advance directives and informed consent 

Psychiatric advance directives introduce predetermined choices made by patients during a time when they are capable of decision-making. Informed consent is typically reliant on a patient's present understanding and voluntarism, but psychiatric advance directives operate during a period when a patient's capacity to consent may be impaired. 

The existence of psychiatric directives therefore creates two distinct phases of informed consent:

• While creating a psychiatric advance directive, the patient can provide informed consent, meaning they can voluntarily make decisions with a clear understanding of the available options. At this point, traditional informed consent principles come into play fully and patients can fully exercise their autonomy. 
• When a situation occurs during which the directive is activated, the dynamics around informed consent change. The directive guides treatment in the absence of a patient's ability to consent. Consent therefore is predetermined and decisions are prefixed based on the patient's previous decisions. The directive is stored with the treating practitioner or shared amongst providers through HIPAA compliant email like Paubox. 

Related: Top 12 HIPAA compliant email services

FAQs

What is informed consent? 

It is the process through which a patient learns about and understands the risks, benefits, and alternatives of a medical treatment before agreeing to it. 

When is informed consent necessary? 

Before any medical treatment, procedure, or participation in research.

What is a medical directive? 

A legal document specifying a person's preference for general medical treatment when they cannot communicate their wishes.