An International Comparison of Psychiatric Advance Directive Policy: Across eleven jurisdictions and alongside advance directive policy

IF 1.3 4区 医学 Q1 LAW
Sophie Gloeckler , Matthé Scholten , Penelope Weller , Alexander Ruck Keene , Soumitra Pathare , Ramya Pillutla , Leticia Andorno , Nikola Biller-Andorno
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Abstract

The present work provides a comparative policy review of psychiatric advance directives, considering 1) variation across eleven international jurisdictions and 2) differentiation from other advance directive policy. The aim is to support well-founded legal and clinical practice when it comes to psychiatric advance directives by 1) clarifying the range of present approaches and 2) highlighting differential treatment of those with mental health conditions. Applicable statutes in England and Wales; Germany; India; the Netherlands; New South Wales (Australia), Northern Ireland, Virginia (USA); Washington (USA); Switzerland; Scotland; and Victoria (Australia) were reviewed by a team with expertise in law, clinical practice, and ethics. Policy variations were identified related to requirements for validity, activation, amendment, revocation, and override of preferences expressed. Psychiatric advance directives tend to be more strictly regulated and have less legal force than medical advance directives, with more restrictive guidelines and more conditions allowing advance preferences to be overridden. Psychiatric advance directives also tend to be less uniform across jurisdictions, sometimes reflecting varied functions of the directive and sometimes suggesting varied framing of the appropriateness of coercion in psychiatric care. More work is needed to evaluate the validity of distinct psychiatric advance directive policy. Stricter regulation and weaker legal force can serve as barriers to use, and coercion carries associated harms; psychiatric advance directive policy, especially choices that differ from other advance directive policy, should be well-justified.
精神病学预先指示政策的国际比较:跨越11个司法管辖区和预先指示政策
本工作提供了一个比较政策审查的精神病学预先指示,考虑1)在11个国际司法管辖区的差异和2)从其他预先指示政策的区别。其目的是支持有充分根据的法律和临床实践,当涉及到精神病学预先指示时,1)澄清现有方法的范围,2)强调对精神健康状况患者的不同治疗。英格兰和威尔士的适用法规;德国;印度;荷兰;新南威尔士(澳大利亚)、北爱尔兰、弗吉尼亚(美国);华盛顿(美国);瑞士;苏格兰;和维多利亚(澳大利亚)由一个具有法律、临床实践和伦理专业知识的小组进行审查。政策变化被确定为与有效性、激活、修改、撤销和覆盖所表达的偏好相关的需求。精神科预先指示往往受到更严格的监管,比医疗预先指示的法律效力更小,有更多的限制性指导方针和更多的条件允许预先偏好被推翻。精神病学预先指示在各个司法管辖区也往往不太统一,有时反映了指示的不同功能,有时暗示了精神病学护理中强迫的适当性的不同框架。需要更多的工作来评估不同的精神病学预先指示政策的有效性。更严格的监管和较弱的法律力量可能成为使用的障碍,而胁迫会带来相关的危害;精神科预先指示政策,特别是与其他预先指示政策不同的选择,应该有充分的理由。
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来源期刊
CiteScore
4.70
自引率
8.70%
发文量
54
审稿时长
41 days
期刊介绍: The International Journal of Law and Psychiatry is intended to provide a multi-disciplinary forum for the exchange of ideas and information among professionals concerned with the interface of law and psychiatry. There is a growing awareness of the need for exploring the fundamental goals of both the legal and psychiatric systems and the social implications of their interaction. The journal seeks to enhance understanding and cooperation in the field through the varied approaches represented, not only by law and psychiatry, but also by the social sciences and related disciplines.
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