Overriding psychiatric advance directives: factors associated with psychiatrists' decisions to preempt patients' advance refusal of hospitalization and medication.

Journal Article (Journal Article)

Psychiatric advance directives (PADs) are intended to support patients' treatment decisions during a crisis. However, PAD statutes give clinicians broad discretion over whether to carry out patients' advance instructions. This study uses data from a survey of psychiatrists (N=164) to examine reasons for overriding PADs. In response to a hypothetical vignette, 47% of psychiatrists indicated that they would override a valid, competently-executed PAD that refused hospitalization and medication. PAD override was more likely among psychiatrists who worked in hospital emergency departments; those who were concerned about patients' violence risk and lack of insight; and those who were legally defensive. PAD override was less likely among participants who believed that involuntary treatment is largely unnecessary in a high-quality mental health system.

Full Text

Duke Authors

Cited Authors

  • Swanson, JW; Van McCrary, S; Swartz, MS; Van Dorn, RA; Elbogen, EB

Published Date

  • February 2007

Published In

Volume / Issue

  • 31 / 1

Start / End Page

  • 77 - 90

PubMed ID

  • 16718578

International Standard Serial Number (ISSN)

  • 0147-7307

Digital Object Identifier (DOI)

  • 10.1007/s10979-006-9032-1


  • eng

Conference Location

  • United States