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Psychiatric Advance Directives

Origins, Benefits, Challenges, and Future Directions


Journal of Psychiatric Practice®: July 2019 - Volume 25 - Issue 4 - p 303–307
doi: 10.1097/PRA.0000000000000401

Psychiatric advance directives (PADs) are legal documents that allow individuals with psychiatric illness to designate decisions, while competent, about their future psychiatric care were they to lose competency due to psychiatric illness in the future. Among other items, these documents often include preferences regarding a surrogate decision-maker, types of medications, doses and routes of medications, seclusion and restraints, electroconvulsive therapy, and instructions for care of their property while incapacitated. While the concept and legal recognition of PADs has existed in the United States for several decades, use of PADs by patients and familiarity with PADs among mental health providers remain limited. This column reviews the origin of PADs, discusses several commonly considered arguments for and against the use of these documents, and concludes with a discussion of how PADs are currently used in the United States and their potential future role in mental health treatment.

MURRAY: Dr Murray is a third-year Psychiatry Resident at the University of Colorado at Denver, Aurora, CO

WORTZEL: Dr Wortzel is the Michael K. Cooper Professor of Neurocognitive Disease, Director of Neuropsychiatry, an Associate Professor in Psychiatry, Neurology, and Physical Medicine and Rehabilitation, and Faculty for the Forensic Psychiatry Fellowship at the University of Colorado at Denver, Aurora, CO. He is Director of Neuropsychiatric Services for the Rocky Mountain MIRECC at the VA Rocky Mountain Regional Medical Center, Aurora, CO

The authors declare no conflicts of interest.

Please send correspondence to: Department of Psychiatry Anschutz Medical Campus, 13001 E 17th Place, Fitzsimons Building, 2nd Floor, Suite C2000, Aurora, CO 80045 (e-mail:

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