An Advance Directive (AD) also known as Psychiatric Advanced Directives (PADs) is a document that specifies a person’s future preferences for treatment, should he or she lose the mental ability to make treatment decisions (MCA 2005). The significance of advance decision-making is endorsed by the Codes of Practice for both the updated Mental Health Act 1983 and the Mental Capacity Act 2005. However its relevance and appropriate use has generated significant debates in many westernised cultures (Brock DW 1993)
Henderson C et al (2004) concluded that the use of joint crisis plans (a form of PAD) reduced compulsory admissions and treatment in patients with severe mental illness. Backlar (1997) and Pearlman (1994) suggested that PADs could improve collaboration among mental health professionals, consumers, and family members. However Kim et al (2007) noted that limited knowledge of PADs among service providers and the difficulty communicating PADs to inpatient staff limited their usefulness.
The proponents of PADs believe that its use preserves the rights and autonomy of the mentally ill by allowing them the right to participate in their own health care when they are competent to make health care decisions. Opponents, on the other hand, believe that they are undesirable and unworkable in practice and that giving mentally ill persons a right to consent to, or refuse, mental health treatment before the onset of any psychiatric illness does not actually promote or protect the best interests of the mentally ill since future decisions cannot be made about potentially unforeseen circumstances (Bogdanoski 2009).
In the mist of these debates, there have been several publications on the use, advantages/disadvantages and associated problems in...
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...didates for the qualitative approach which explores individual experiences by using dialogues and emergent view that delve beneath surface. When the quantitative phase is followed by the qualitative phase, the intent may be to help determine the best participants with which to follow up or to explain the mechanism behind the quantitative results (Plano Clark, 2010).
Elbogen et al (2006), which surveyed only clinicians’ views and attitudes on the use of PADs, randomly selected participants using online survey with links on the relevant professional bodies and attached a $50 voucher attached to completed survey.
These studies all identified the need for further research on the utility of PADs and I believe the first step would be generating hypothesis and interpreting data from the lived experiences of a representative sample group (clinicians and patients).
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