ABSTRACT
Advance directives seem at first glance to be both simple and straightforward. When well (or ‘capable’) a person writes down how they want to be treated when they become too unwell (or ‘incapable’) to make that decision for themselves. This would seem to be the epitome of respecting a person’s wishes (autonomy) and also having them involved in decision-making about their treatment, which may improve communication and collaboration with staff. In most people’s minds it is probably associated with refusal of treatment in end-of-life situations and may be used synonymously with ‘living wills’ or ‘do not resuscitate’ (DNR) orders.1 They have been discussed and promoted in the media, particularly following the death of the popular Labour politician Mo Mowlam who died in 2005 and who had one in place following her diagnosis with a brain tumour. It is not surprising that there has been interest expressed by people with mental illness in
advance directives.2 They have been adopted by parts of the user movement as a way of promoting patient choice and autonomy and may be seen as part of a wider involvement of patients in their treatment. The reality of using advance directives is not so straightforward, however, particularly when they are applied to mental illness. This chapter will explore some of these issues.
