Psychiatric Advance Directives*

Approved by the Joint Reference Committee, May 2009

Advance directives were developed in the context of end of life care and are generally associated with medical and surgical decision-making for permanently incapacitated patients. Within psychiatry, interest in advance directives has been expressed as a means of facilitating the treatment of individuals afflicted with serious mental illnesses (Appelbaum, 1979). These disorders are typified by recurrent episodes of severe, cognition-impairing symptomatology that often result in decisional incapacity. Psychiatric advance directives (PADs) hold the promise of allowing individuals with mental illness, during a time of stability, to record treatment preferences that will presumptively guide the direction of care during incapacitating periods of illness.