 'Advance
directives' or 'living wills' were originally designed for
terminally ill patients. They are now seen as increasingly
relevant to psychiatry, where self-determination has been
recognised as a fundamental ethical principle.
Following the recent
implementation of the Mental Capacity Act 2005, there are two
sorts of advance decisions – advance statements and Advance
Decisions to Refuse Treatment (ADRTs).
These anticipate a time when the capacity
to make a treatment decision has been lost, and detail a person’s
wishes for future medical treatment. As such, they are a way of
enhancing patient autonomy and choice.
As advance treatment refusals become more commonplace in
clinical practice, psychiatrists may well be called upon to give an
opinion about a person’s capacity to make an ADRT or be presented
with one by a patient. Thus, they need to feel confident in this
area.
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This module will:
- define the terminology used in advance decision-making,
emphasising the differences between advance statements and
ADRTs
- discuss the relevant legal issues and the assessment of
capacity, which is crucial in this area
- highlight the particular conflict of ADRTs and the Mental
Health Act 1983
- look at the risks and benefits of having an ADRT (and how to
discuss these with patients)
- illustrate the practicalities of advance decision-making with
some case examples
- set out the criteria for when an ADRT may be invalid.
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Start the module
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NB: This module covers advance decisions in
England and Wales only. For Ireland, please see the
module Advance directives in
Ireland.
Advance statements and the law in Scotland will
also be published soon.
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 Download Take-home notes to print and
annotate
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