Psychiatric Advance Directives Under the Convention on the Rights of Persons With Disabilities: Why Advance Instructions Should Be Able to Override Current Preferences
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Psychiatric advance directives (PADs) are documents by means of which mental health service users can make known their preferences regarding treatment in a future mental health crisis. Many states with explicit legal provisions for PADs have ratified the United Nations (UN) Convention on the Rights of Persons with Disabilities (CRPD). While important UN bodies consider PADs a useful tool to promote the autonomy of service users, we show that an authoritative interpretation of the CRPD by the Committee on the Rights of Persons with Disabilities has the adverse consequence of rendering PADs ineffective in situations where they could be of most use to service users. Based on two clinical vignettes, we demonstrate that reasonable clinical recommendations can be derived from a more realistic and flexible CRPD model. Concerns remain about the accountability of support persons who give effect to PADs. A model that combines supported decision making with competence assessment is able to address these concerns.
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The understanding of advance statements/directives becomes problematic under the CRPD Committee's interpretation, creating a significant inconsistency.
“Actually, the understanding of the implications of an advance statement or directive becomes problematic in this Committee's interpretation, throwing up a significant inconsistency 60,61 .”
From Ethical challenges in contemporary psychiatry: an overview and an appraisal of possible strategies and research needs (2024) · cites this paper as [61]
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Advance directives in psychiatry to foster self-determination: a proposal for the Italian scenario
Ienco, G., & Porteri, C. (2026) · Medicine Health Care and Philosophy · doi:10.1007/s11019-026-10363-1
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Las voluntades anticipadas en salud mental
Barrios, L. M. (2026) · Ediciones Comunicación Científica eBooks · doi:10.52501/cc.390.05
Rethinking restraint in psychiatric services: A Kantian ethical and legal analysis
Ayhan, C. H., Akkoyun, S., Aslan, K., & Polat, B. T. (2026) · Nursing Ethics · doi:10.1177/09697330261476255
- Authors
- Scholten, M., Gieselmann, A., Gather, J., & Vollmann, J.
- Affiliations
- Ruhr University Bochum (DE)
- University Hospitals of the Ruhr-University of Bochum (DE)
- Corresponding author
- Scholten, Matthé
- Venue
- Frontiers in Psychiatry
- Publisher
- Frontiers Media SA
- Published
- 2019-09-11
- Volume
- 10
- Pages
- 631-631
- ISSN
- 1664-0640 (ISSN-L)
- PMC
- PMC6749547
- OpenAlex
- W2965991659
- Cited by
- 56
- References
- 55
- Citations by year
- 2026: 6 · 2025: 9 · 2024: 8 · 2023: 7 · 2022: 9 · 2021: 7 · 2020: 9 · 2019: 1
- FWCI
- 7.59
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Frontiers in Psychiatry (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Bundesministerium für Bildung und Forschung
- Topics
- Social Sciences › Psychology › Clinical Psychology › Healthcare Decision-Making and Restraints
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
- Health Sciences › Health Professions › General Health Professions › Health, Medicine and Society
- Keywords
- psychiatric advance directives, Convention on the Rights of Persons with Disabilities, UN Committee on the Rights of Persons with Disabilities, supported decision-making, competency assessment, mental health service users, clinical guidelines
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