Psychiatric Advance Directives
Psychiatric advance directives are legal documents completed by individuals living with mental illness to document preferences for future treatment in advance of a health crisis. These documents should be completed at a time of wellness when a person is able to think about their preferences and priorities for future mental health treatments.
While there is no special advance directive for psychiatric care in Vermont, the Long Form Advance Directive or Disability Rights Vermont Form may be helpful to document what to do if a person loses capacity to give or withhold consent for treatment during an acute episode of a psychiatric illness.
Some of the Decisions You Can Make
- Name the person(s) you authorize to make health decisions for you if you are unable to make decisions for yourself
- List other people who can be consulted or should not be consulted about medical decisions on your behalf
- If a medical guardian is needed in the future, you can ask the court to consider appointing someone you have listed in your document
- Identify the hospital or treatment facility you prefer if you need in-patient care, as well as the facility/facilities you would prefer to avoid
- List medications or treatments that have worked well for you in the past
- List medications or treatments to avoid
- Give more specific information and preferences if emergency involuntary treatment is necessary
- Outline your preferences surrounding the use of electro-convulsive therapy (ECT)
Waiver of the Right to Request or Object to Treatment [18 V.S.A §9707(h)]
There may be situations in which you could anticipate objecting to or requesting treatment at a time of incapacity and would want your objections or requests to be disregarded (Part 6 of the Long Form Advance Directive).
Because this is a basic right that all patients have (to refuse treatment) unless a court orders otherwise, such a decision requires careful thought. Additional signatures and assurances will be needed if you include this type of provision in your advance directive.
For your health care agent to be able to make healthcare decisions over your objection, you will need to:
- Specify the treatments you are allowing your agent to consent to or refuse over your objection
- State that you either do or do not desire the specified treatment even over your objection at the time and, further, specify your wishes related to voluntary and involuntary treatment and release from that treatment or facility
- Acknowledge in writing that you are knowingly and voluntarily waiving the right to refuse or receive specified treatment at a time of incapacity
- Have your agent agree in writing to accept the responsibility to act over your objection
- Have your clinician affirm in writing that you appeared to understand the benefits, risks, and alternatives to the proposed health care being authorized or rejected by you in this provision
- Have an ombudsman, mental health patient representative, attorney licensed to practice in Vermont, or a probate court designee affirm in writing that he or she has explained the nature and effect of this provision to you and that you appeared to understand this explanation and be free from duress or undue influence.
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