TY - JOUR
T1 - Opportunities and challenges of self-binding directives
T2 - A comparison of empirical research with stakeholders in three European countries
AU - Scholten, Matthé
AU - Efkemann, Simone Agnes
AU - Faissner, Mirjam
AU - Finke, Marleen
AU - Gather, Jakov
AU - Gergel, Tania
AU - Gieselmann, Astrid
AU - van der Ham, Lia
AU - Juckel, Georg
AU - van Melle, Laura
AU - Owen, Gareth
AU - Potthoff, Sarah
AU - Stephenson, Lucy A.
AU - Szmukler, George
AU - Vellinga, Astrid
AU - Vollmann, Jochen
AU - Voskes, Yolande
AU - Werning, Anna
AU - Widdershoven, Guy
N1 - Publisher Copyright: © The Author(s), 2023. Published by Cambridge University Press on behalf of the European Psychiatric Association.
PY - 2023/6/9
Y1 - 2023/6/9
N2 - Background Self-binding directives (SBDs) are psychiatric advance directives that include a clause in which mental health service users consent in advance to involuntary hospital admission and treatment under specified conditions. Medical ethicists and legal scholars identified various potential benefits of SBDs but have also raised ethical concerns. Until recently, little was known about the views of stakeholders on the opportunities and challenges of SBDs. Aims This article aims to foster an international exchange on SBDs by comparing recent empirical findings on stakeholders' views on the opportunities and challenges of SBDs from Germany, the Netherlands, and the United Kingdom. Method Comparisons between the empirical findings were drawn using a structured expert consensus process. Results Findings converged on many points. Perceived opportunities of SBDs include promotion of autonomy, avoidance of personally defined harms, early intervention, reduction of admission duration, improvement of the therapeutic relationship, involvement of persons of trust, avoidance of involuntary hospital admission, addressing trauma, destigmatization of involuntary treatment, increase of professionals' confidence, and relief for proxy decision-makers. Perceived challenges include lack of awareness and knowledge, lack of support, undue influence, inaccessibility during crisis, lack of cross-agency coordination, problems of interpretation, difficulties in capacity assessment, restricted therapeutic flexibility, scarce resources, disappointment due to noncompliance, and outdated content. Stakeholders tended to focus on practical challenges and did not often raise fundamental ethical concerns. Conclusions Stakeholders tend to see the implementation of SBDs as ethically desirable, provided that the associated challenges are addressed.
AB - Background Self-binding directives (SBDs) are psychiatric advance directives that include a clause in which mental health service users consent in advance to involuntary hospital admission and treatment under specified conditions. Medical ethicists and legal scholars identified various potential benefits of SBDs but have also raised ethical concerns. Until recently, little was known about the views of stakeholders on the opportunities and challenges of SBDs. Aims This article aims to foster an international exchange on SBDs by comparing recent empirical findings on stakeholders' views on the opportunities and challenges of SBDs from Germany, the Netherlands, and the United Kingdom. Method Comparisons between the empirical findings were drawn using a structured expert consensus process. Results Findings converged on many points. Perceived opportunities of SBDs include promotion of autonomy, avoidance of personally defined harms, early intervention, reduction of admission duration, improvement of the therapeutic relationship, involvement of persons of trust, avoidance of involuntary hospital admission, addressing trauma, destigmatization of involuntary treatment, increase of professionals' confidence, and relief for proxy decision-makers. Perceived challenges include lack of awareness and knowledge, lack of support, undue influence, inaccessibility during crisis, lack of cross-agency coordination, problems of interpretation, difficulties in capacity assessment, restricted therapeutic flexibility, scarce resources, disappointment due to noncompliance, and outdated content. Stakeholders tended to focus on practical challenges and did not often raise fundamental ethical concerns. Conclusions Stakeholders tend to see the implementation of SBDs as ethically desirable, provided that the associated challenges are addressed.
KW - Advance statement
KW - Ulysses arrangement
KW - crisis plan
KW - psychiatric advance directive
KW - self-binding directive
UR - http://www.scopus.com/inward/record.url?scp=85162245356&partnerID=8YFLogxK
U2 - https://doi.org/10.1192/j.eurpsy.2023.2421
DO - https://doi.org/10.1192/j.eurpsy.2023.2421
M3 - Article
C2 - 37293987
SN - 0924-9338
VL - 66
JO - European psychiatry
JF - European psychiatry
IS - 1
M1 - e48
ER -