Competent adults can withhold or give consent to all treatment decisions that affect their health. This fundamental right to autonomous decision-making is protected even after the person is no longer competent. The practical way for competent adults to protect this right is to write their wishes regarding medical and psychiatric care in documents that are referred to as "advance directives." Advance directives for medical care include, but are not limited to, a living will and the appointment of a health care surrogate. The mental health advance directive gives clients the opportunity to participate in their care even when they have lost their decisional capacity.

A living will is a document that outlines specific instructions regarding end-of-life choices. These choices can include a wish to accept or decline medical procedures such as: a) mechanical ventilation; b) feeding tube; c) dialysis; d) organ donation; and others. Living wills are limited by two major factors. The first is that people cannot predict all possible medical scenarios under which a living will may apply; and second, the living will can be implemented only when the person is very seriously ill with any one of the following three medical conditions: 1) a terminal; 2) end-stage; or 3) persistent vegetative state. Definitions of these terms are outlined in Florida Statutes.

Competent adults can also designate a health care surrogate, a specific person chosen to make health care decisions for them when they become mentally or physically incapacitated.

A mental health advance directive is a document that can be completed by currently competent mental health clients, who believe that in the future they may not be capable of making rational decisions about their mental health care. This document could be used to make their mental health care preferences known to their doctors. Mental health preferences can include: choice of treatment facility and doctor; release of psychiatric records; medications; elecroconvulsive therapy; and the choice of restraints.

Health care providers resort to implementing advance directives only when communication becomes impossible due to severe medical and/or psychiatric illness. Guardianship is frequently used to serve the same purpose. However, guardianship is a legal procedure that is costly, and it is frequently not time efficient. Advance directives do not require an attorney to complete, nor do they require a notary public's seal. Advance directives documents become legal when they are signed, dated, and witnessed.

For more information about advance health care planning, you may contact Hana Osman, Ph.D., e-mail address: hosman@fmhi.usf.edu, or by telephone: (813) 974-0989.

© 2002, Florida Coalition for Optimal Mental Health & Aging